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Choroidal Neovascularization

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Pathologic Myopia

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Abstract

High myopia is associated with excessive and progressive elongation of the globe, resulting in a variety of fundus changes that lead to visual impairment; one of the most common and severe is choroidal neovascularization. It is manifested by loss of acuity, scotomata, and distortion of vision. Several factors are frequently found in myopic CNV as compared with other common forms of CNV, such as that due to age-related macular degeneration. A common precursor to neovascularization is lacquer cracks, which are breaks in Bruch’s membrane. The size of the neovascularization is often small in highly myopic eyes, there is less evident leakage during fluorescein angiography, and optical coherence tomography usually does not show much fluid in either the subretinal space or within the retina. Unfortunately the patients generally are young, in the most productive periods of their lives. Treatment for CNV used to involve thermal laser photocoagulation, which caused expanding areas of atrophy. Photodynamic therapy has been used but with disappointing results. Introduction of therapies directed against vascular endothelial growth factor caused a large change in the outcomes for patients with myopic CNV. In this chapter the characteristics of myopic CNV is presented. The history of treatments for myopic CNV is discussed in detail, and a general approach to patients with myopic CNV is shown. Finally, a hypothesis is generated to explain the frequent observation of atrophy following treatment for myopic choroidal neovascularization.

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  1. Vitreous, Retina, Macula Consultants of New York, East 72nd St. 519, Suite 203, New York, NY, 10021, USA

    Richard F. Spaide MD

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  1. Vitreous, Retina, Macula Consultants of New York, New York, New York, USA

    Richard F. Spaide

  2. Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan

    Kyoko Ohno-Matsui

  3. Department of Clinical Ophthalmology, Columbia University School of Medicine, LuEsther T. Mertz Retinal Research Center, New York, New York, USA

    Lawrence A. Yannuzzi

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Spaide, R.F. (2014). Choroidal Neovascularization. In: Spaide, R., Ohno-Matsui, K., Yannuzzi, L. (eds) Pathologic Myopia. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8338-0_15

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