Characteristics of pathological myopia macular degeneration Usually myopia over -8.00D and an eye axis over 26mm with fundus lesions are called pathological myopia. The cause of macular degeneration in pathological myopia may be due to the growth of the eye axis, liquefaction degeneration of the vitreous and insufficient blood supply to the choroidal vessels, which in turn leads to damage to the choroidal capillary-Bruch’s membrane-RPE complex, resulting in a series of pathological damage to the macula. Typical fundus features of pathologic myopic macular lesions include lacquer-like cracks, macular hemorrhage, exudation, edema, gray macular lesions or Fuchs’ spots, diffuse and focal choroidal atrophy, secondary retinal splitting, central hollow detachment, macular fissure, and posterior chylomegaly. According to the different fundus manifestations of patients, pathological myopic macular lesions are currently classified internationally into five categories: lacunar cracked macular lesions, neovascular pathological myopic macular lesions, lacunar cracked macular hemorrhages, atrophic pathological myopic macular lesions, and myopic implicated macular lesions. The common clinical treatment for macular hemorrhage due to pathological myopia may be choroidal neovascularization (CNV) hemorrhage or macular hemorrhage due to lacquer-like fissures, which are treated differently. How do you go about distinguishing what causes macular hemorrhage? Prof. Wen said that the presence or absence of CNV is the most critical point of differentiation through fluorescein fundus angiography (FFA). CNV pathological myopic maculopathy Histopathological studies have found that CNV is present in 5.2% of pathological myopia, while the typical clinical symptoms of CNV pathological myopic maculopathy include decreased visual acuity, dark shadows and visual distortion, which are not characteristic. Some auxiliary examinations, such as fundus photography, FFA or OCT to detect CNV lesions in the fundus are important for the diagnosis of the disease. Since the fundus of pathological myopia often shows changes such as atrophy and lacquer-like cracks at an early stage, which makes it difficult to detect CNV traces by conventional fundus examination, the advantages of FFA examination and OCT examination are obvious. Studies have shown that FFA is more sensitive than OCT in showing CNV in pathological myopia. Therefore, Prof. Wen Feng suggests that FFA should be performed as early as possible along with OCT for patients with significant visual symptoms of pathological myopia. The risk factors for CNV pathological myopic macular lesions include age, female, choroidal thinning, paracentral focal atrophy, paracentral lacunar crack, and the presence of CNV in the contralateral eye, and the overall risk of CNV in high myopia is as high as 30%. If left untreated, the patient’s vision will be seriously compromised and eventually form an atrophic Fuchs’ spot, causing permanent damage to vision. Lacrimal macular lesion and hemorrhage Lacrimal crack is a relatively early lesion of pathological myopia, which is currently believed to be the result of Bruch’s membrane cracking due to the growth of the eye axis, and in the process of Bruch’s membrane cracking, the adjacent choroidal vessels are often pulled and ruptured, resulting in hemorrhage. Lacrimal macular hemorrhage generally manifests as a round-like hemorrhagic foci without exudation or edema in the fundus, and there is no CNV on FFA examination. This hemorrhage is usually absorbed by medication and there is no obvious atrophic scar, and the visual prognosis is better than CNV. Atrophic and implicated macular lesions 40% of pathological myopia will progress to macular atrophy, which can be manifested as diffuse atrophy or focal atrophy, with focal atrophy causing more damage to vision than diffuse. Patients with pathological myopia have longer eye axes, severe posterior vitreous detachment and posterior scleral staphyloma, and vitreoretinal involvement diseases such as macular cleavage and fissure are common, often requiring surgical intervention for treatment. The clinical fundus manifestations of pathological myopia are complex, and various types often appear together. In the treatment, it is necessary to distinguish the primary and secondary conflicts, and to first address the factors that are harmful to vision. Among them, CNV, especially active CNV, is particularly harmful to vision. Timely and effective anti-VEGF treatment can effectively promote the absorption of CNV hemorrhagic exudation, improve the patient’s visual acuity, and avoid extensive permanent visual impairment. In addition, the long course of pathological myopia emphasizes that regular follow-up can also help detect early CNV lesions, while timely anti-VEGF therapy is recommended for active CNV lesions.