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Year : 1983  |  Volume : 31  |  Issue : 3  |  Page : 153-157

Fluorescein angiographic study of myopic macula


Institute of Ophthalmology, Aligarh Muslim University, Aligarh, India

Correspondence Address:
B S Goel
Institute of Ophthalmology, Aligarh Muslim University, Aligarh
India
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Source of Support: None, Conflict of Interest: None


PMID: 6676204

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How to cite this article:
Goel B S, Lal B. Fluorescein angiographic study of myopic macula. Indian J Ophthalmol 1983;31:153-7

How to cite this URL:
Goel B S, Lal B. Fluorescein angiographic study of myopic macula. Indian J Ophthalmol [serial online] 1983 [cited 2024 Mar 28];31:153-7. Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?1983/31/3/153/29773

The reports regarding the fluorescein fundus angiography in high myopia are few and more so pertaining to study of macular region in this disease. The present study, therefore, deals with the fiuorescein angiography in myopic macula.


  Material and Methods Top


The present investigation was undertaken in 57 eyes of 38 individuals at the Institute of Ophthalmology, Aligarh Muslim University, Aligarh. The eyes were divided into three groups depending upon the history and clinical examination of the fundus.

Group I-Normal eyes (9 eyes)

All of these eyes were normal and had no abnormality in either the anterior or the posterior segment.

Group II-Simple Myopia (25 eyes)

These eyes were considered to be simple myopic because there was either complete absence or minimal degenerative changes in the central fundus. Their refractive error ranged from-5.5 D. spherical to-12.0 D. spherical.

Group III-Pathological myopia (23 eyes).

These eyes had a widespread central and peripheral degenerative changes in the fundus. The prominent degenerative changes included a large myopic crescent, peripapillary choroidal atrophy, central macular degenerative changes and Foster Fuch's flecks.

Fluorescein fundus angiography was undertaken in all the eyes with the help of the latest Carl Zeiss fluores­cein angiographic equipment having an automated pentax camera with a dalaphot system and a high speed flash generator. 5 ml of 10% sodium fluorescein dye was injected in the antecubital vein and the fundus photo­graphs were taken after swinging in the excitor filter knob. A series of photographs were taken at a preset interval of 1 second upto 20 seconds and later at approximately 1, 3, 5, 10 and 15 minutes intervals. ORWO, 400 ASA, 35 MM. film was used in the present investigation. The fluorangiograms were studied with the help of a projector and the interpretation of macular fluorescence was done.


  Observations Top


The ophthalmoscopic and fluorangiographic observations of the macular area in all the three groups are described as follows.

Group I (Normal eyes)

No ophthalmoscopic and fluorangiographic abnormality was observed in all the 9 eyes. The macular area appeared darker and the fine retinal parafoveal capillaries forming a dense arcade were clearly observed [Figure - 1].

Group II (Simple myopia)

In all the 25 eyes, no clinical and fluoran­giographic abnormality were observed [Figure - 2].

Group III (Pathological myopia)

However, a number of findings were obser­ved in the macula in this group.

(a) Ophthalmoscopic appearance

A dull foveal reflex and pigment mottling of varied density was observed in 5 (21.74%) eyes and an irregular dark patch (Forster Fuch's flecks) was observed in the macular area (2 eyes-8.7%) and in the paramacular area (1 eye­4.35%). However, in 1 eye out of above eyes, the dark patch was situated in the centre with two pigmentary epithelium defects on either side of it. One eye revealed a macular coloboma with little pigment.

(b) Fluorescein angiographic appearance

Fluorangiographically, a number of findings were observed in 14 (60.8%) out of 23 eyes as follows:

(1) Localized hyperfluorescence

Localized or patchy hyperfluorescence was observed in the paramacular area of 3(13.04%) eyes in the late venous phase of the dye transit [Figure - 3][Figure - 4]. The patches represent chorio-retinal atrophy in these areas.

(2) Diffused hyperfluorescence

A diffuse type of hyperfluorescence was observed in 1(4.35%) eye in the paramacular area [Figure - 5]. The area represents some pigment epithelium disturbance.

(3) Hyperfluorescence in the region of Forster Fuch's fleck

In 2(8.7%) eyes an area of hyperfluorescence with a nonfluorescent rim was noticed. In 1 (4.35%) eye, the associated pigment epithelium defect on either side of Fuch's spot also contri­buted in hyperfluorescence in this area and was seen to be larger and matted together in the centre [Figure - 6]. In 1 (4.35%) eye, a diffused, but less defined paramacular hyperfluoresence was Observed in the region of Forster Fuch's spot [Figure - 7]. In the third eye, the area of hyper fluorescence was markedly seen in the late phase of dye transit [Figure - 8].

(4) Choroidal sclerosis

In ](4.35%) out of 23 eyes, macular area revealed sclerosed choroidal vessels and they contained no fluorescein in their lunen [Figure - 9].

(5) Macular coloboma

The early fluorangiogram of 1(4.35%) eye, revealed an area of hypofluorescence, and a few isolated choroidal vessels in the region of coloboma [Figure - 10] and in the late phase, a diffused hyperfluorescence with clear cut margins was observed [Figure - 11].

(6) Macular degeneration

5 eyes having a dull foveal reflex & pig­ment mottling on ophthalmoscopic examin­ation, did not reveal any abnormality on fluorescein fundus angiography.


  Discussion Top


The macular area in myopic eyes has aroused the maximum interest of many ophthalmologists because of a number of degenerative changes seen in this region which in turn are responsible for poor visual acuity in the majority of the eyes. In normal eyes and in eyes with simple myopia, the dark macula represents a fairly normal pigment epithelium in this region rich in pigments. On the other hand, in eyes with pathological myopia, where the retinal pigment epithelium is comparatively unhealthy, various fluorangiographic findings suggest that the area has got a choroidal is­chaemia of various degrees. Patchy hyper­fluorescence in the paramacular area, represents that the choroidal atrophy leading to pigment epithelium defects is the main factor involved in the late scleral staining in these parts. Pre­sence of apparent sclerosed choroidal vessels seen in this area further suggest that choroidal ischaemia is a mojor factor in causing various chorioretinal degenerative conditions in these areas.

A number of workers have reported the occurence of subretinal neovascular membrane (SRNM) in the macular area underlying Fuch's spot. However, in the present study such a feature was not observed, although a localized hyperfluorescence as seen in these eyes should be due to leakage from the under lying chorio­capillaris. A nonfluorescent rim, surrounding the hyperfluorescence could be due to some pathology in the RPE representing density of the pigments.


  Summary Top


A comparison of the macula ophthalmo­scopically and fluorangiographically has been made in normal, simple myopic and pathologi­cal myopic eyes. Generally, it was observed that there was no abnormality seen in normal and simple myopic group of cases, whereas disturbances in the pigment epithelium and choroidal vessel filling was observed in patho­logical myopic eyes. Clinical and fluorangio­graphic picture of Forster Fuch's flecks, myopic degeneration of the macula and coloboma of the macular is also described. Commonest find­ings on fluorescein angiography observed were, localized or diffuse hyperfluorescence of the macular and paramacular area and sclerosis and atrophy of the choroidal vessels.


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7], [Figure - 8], [Figure - 9], [Figure - 10], [Figure - 11]



 

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