Influence of posterior staphyloma in myopic maculopathy and visual prognosis

Abstract

Background/objectives: Posterior staphyloma is a hallmark of high myopia and its presence associates to greater degrees of myopic maculopathy. Nonetheless, its development, repercussion on visual function and relationship with maculopathy components, is still unclear. The objective was to analyze the impact of posterior staphyloma on the incidence and severity of myopic maculopathy and its repercussion on visual prognosis.

Subjects/methods: Cross-sectional study conducted on 473 consecutive eyes of 259 highly myopic patients examined at Puerta de Hierro-Majadahonda University Hospital (Madrid, Spain). All patients underwent complete ophthalmologic examination including best corrected visual acuity (BCVA), axial length (AL), myopic maculopathy classification according to ATN system (atrophic/traction/neovascularization), determined the presence of posterior staphyloma, pathologic myopia (PM) and severe PM. Multimodal imaging were performed including fundus photography, optical coherence tomography (OCT), OCT-angiography, fundus autofluorescence and/ or fluorescein angiography.

Results: Out of the total, 70.65% were female patients (n = 173/259), mean BCVA was 0.41 ± 0.54 logMAR units and mean AL was 29.3 ± 2.6 mm (26-37.6). Posterior staphyloma was present in 69.4% of eyes. Eyes with posterior staphyloma compared to non-staphyloma were older (p < 0.05), had greater AL (p < 0.01), worse BCVA (p < 0.01) and higher stage in ATN components (p < 0.01). Moreover, compound subgroup showed worse BCVA (p < 0.01) and greater stage in each of the ATN components (p < 0.01). Staphylomas with macular involvement presented worse BCVA (p < 0.01), higher AL (p < 0.01), and greater ATN (p < 0.05). The risk of posterior staphyloma presence in eyes with PM and severe PM eyes was 89.8% and 96.7%, respectively. Posterior staphyloma was the best predictor for BCVA in myopic patients (p < 0.01).

Conclusions: Posterior staphyloma's presence determines high risk of myopic maculopathy and therefore worse visual prognosis, especially those with macular involvement. Posterior staphyloma represented the best predictor for BCVA in highly myopic patients.

Fig. 1. Color fundus photography showing different posterior staphyloma subtypes [20].

A Left eye wide macular posterior staphyloma (type I); B Right eye presenting a narrow macular posterior staphyloma (type II); C Right eye demonstrating the nasal type (type IV) posterior staphyloma; D Right eye combining peripapillary area and wide macular staphyloma (type VII/Others in Ohno-Matsui classification [8]); E Left eye posterior staphyloma associating a vertical septum from upper to lower border of the staphyloma (Type IX/Others in Ohno-Matsui classification [8]) and F Right eye compound posterior staphyloma type VIII (Others in Ohno-Matsui classification [8]) associating steps across the wall of a primary type I staphyloma.

Fig. 2. Right high myopic eye with peripapillary subtype (type III) posterior staphyloma.

Color fundus photography (up) showing peripapillary staphyloma and corresponding horizontal OCT b-scan (down) demonstrating an inward protrusion of the sclera and choroid thinning at the edge of the staphyloma.