Characteristics and Prevalence of Staphyloma Edges at Different Ages in Highly Myopic Eyes

Abstract

Purpose: The purpose of this study was to determine the characteristics of staphyloma edges in highly myopic eyes and how they progress.

Methods: We conducted a cross-sectional analysis using baseline data and a longitudinal study with follow-up data from 256 patients (447 eyes) with high myopia, with a mean (SD) follow-up of 3.79 (0.78) years. Participants were divided into four age groups: children (<13), youth (13-24), mature (25-59), and elderly (>60). Ultrawide-field swept-source optical coherence tomography was used to analyze staphyloma edges, which were divided into four areas: nasal to the optic disc (OD), superior to the macula, inferior to the macula, and temporal to the macula.

Results: Staphylomas were significantly more prevalent in the mature (42.49%) and the elderly (51.35%) groups than in the children (13%) and youth (9%) groups. Staphyloma edges were predominantly superior to the macula in the mature and elderly groups. In contrast, staphylomas were rare in children and youth, with their edges mainly located nasal to the OD. The edges of staphylomas located superior and temporal to the macula were more likely to be associated with myopic traction maculopathy. During the follow-up period, 11 new staphyloma edges developed primarily in the mature group (64%). Additionally, 12 edges had an increased degree of protrusion over time, with most cases occurring in the mature (75%) group.

Conclusions: The prevalence and location of staphyloma edges show significant variations depending on age. As time progresses, staphyloma edges manifest at distinct sites and increase their protrusion, potentially playing a role in the emergence of fundus complications.

Figure 1.

Examples of the two types of staphyloma edges. (A) and (B) Type 1 edge. (A) Horizontal ultra-widefield optical coherence tomography (UWF-OCT) image across the fovea of an 11-year-old girl with a refractive error of −8.5 diopters (D) and an axial length (AL) of 27.0 mm. The OCT image shows a staphyloma edge (arrow) on the nasal side of the optic disc. A gradual “thick-thin-thick” change of the choroidal thickness from the periphery toward the edge of the staphyloma and then to the posterior pole, and the inward protrusion of the scleral-choroidal interface can be seen. However, the line of the retinal pigment epithelium (RPE) does not protrude. (B) Magnified view of image A. The RPE line does not protrude despite the choroidal “thick-thin-thick” pattern and inward protrusion of the choroid-scleral interface (arrow). (C) and (D) Type 2 edge. (C) Horizontal UWF-OCT section across the fovea of a 47-year-old woman with a refractive error of −13.5 D and an AL of 28.7 mm. A staphyloma edge is seen temporal to the macula (arrow). In addition to the choroidal “thick-thin-thick” pattern and the inward protrusion of scleral-choroidal interface, the RPE line also protrudes inwardly. (D) Magnified view of image C.

Figure 2.

Staphyloma edges in two eyes from patients in the mature age group. (A) Fundus photograph of the right eye of a 37-year-old man with a refractive error of -16.5 diopters (D) and an axial length (AL) of 30.7 mm showing tessellated fundus. (B) Horizontal ultra-widefield optical coherence tomography (UWF-OCT) image across the fovea shows a staphyloma edge temporal to the macula (arrow). In addition to the inward protrusion of the sclera, the line of the retinal pigment epithelium (RPE) protrudes slightly anteriorly indicating a type 2 edge. (C) Fundus photograph of the right eye of a 47-year-old woman with a refractive error of −13.75 D and an AL of 28.1 mm showing mild diffuse choroidal atrophy in the macula. (D) Vertical UWF-OCT section across the fovea shows a very steep staphyloma edge superior to the macula (white arrow) and a mild staphyloma edge inferior to the macula (red arrow). Both edges show RPE protrusions indicating type 2 edges. (E) Lateral view of 3D reconstruction of widefield OCT images of the same eye in C showing the steep edge (white arrowhead) along the upper margin and mild edge (red arrowhead) along the lower margin of the staphyloma.

Figure 3.

Staphyloma edges in the elderly group. (A) Fundus photograph of the right eye of a 63-year-old man with a refractive error of −11.125 diopters (D) and an axial length (AL) of 26.8 mm showing macular atrophy. The margin of the narrow macular staphyloma is de-pigmented. (B) Arrows indicate ultra-widefield optical coherence tomography (UWF-OCT) scan lines for images C and D. (C) An oblique UWF-OCT image across the fovea shows type 2 staphyloma edge (arrow), which is present in the temporal fundus. (D) Vertical UWF-OCT image across the fovea shows type 2 staphyloma edges superior (red arrow) and inferior to the macula (white arrow). (E) Lateral view of 3D reconstructed optical coherence tomography image shows staphyloma edges along the superior border (red arrowhead) and the inferior border (white arrowhead) of the staphyloma. The inferior edge is steeper than the superior edge. (F) Fundus photograph of the left eye of a 67-year-old woman with an AL of 26.1 mm showing a narrow macular staphyloma as a de-pigmented line. (G) Arrows indicate UWF-OCT scan lines for images H and I. (H) Horizontal UWF-OCT image across the fovea shows a steep type 2 edge in the temporal fundus (arrow). (I) Vertical UWF-OCT image across the fovea shows a type 2 staphyloma edge superior to the macula (arrow). (J) Fundus photograph of the right eye of a 58-year-old woman with a refractive error of −9.75 D and an AL of 26.7 mm showing macular atrophy. The upper edge of the staphyloma appears to be de-pigmented. (K) Arrows indicate the UWF-OCT scan lines for images L and M. (L) Horizontal UWF-OCT image across the fovea of a type 2 staphyloma edge (arrow) located temporal to the macula. (M) Vertical UWF-OCT image across the fovea shows two type 2 edges with one superior (red arrow) and the other inferior (white arrow) to the macula. (N) Lateral view of 3D reconstructed OCT image shows staphyloma edges along the superior border (red arrowhead) and the inferior border (white arrowhead) of a staphyloma. The upper edge is steeper than the lower edge.

Figure 4.

Staphyloma edges in the children and youth groups. (A) Fundus photograph of the right eye of an 11-year-old girl with a refractive error of -8.5 diopters (D) and an axial length (AL) of 27.0 mm showing mild tessellation. (B) Widefield fundus image of the same eye showing OCT scan lines for images C and D. (C) and (D) Ultra-widefield optical coherence tomography (UWF-OCT) images showing a staphyloma edge nasal to the optic disc (arrows). The RPE line protrudes slightly suggesting a type 2 edge. (E) Fundus photograph of the right eye of an 11-year-old girl with a refractive error of −7.5 D and an AL of 26.8 mm showing a tessellated fundus. (F) Widefield fundus image of the same eye showing OCT scan lines for images G and H. (G) and (H) UWF-OCT images showing a staphyloma edge nasal to the optic disc (arrows). The RPE line protrudes slightly suggesting a type 2 edge. (I) Fundus photograph of the left eye of a 15-year-old boy with a refractive error of −15.0 D and an AL of 29.2 mm showing peripapillary diffuse atrophy. (J) Widefield fundus photograph of the same eye showing OCT scan lines for images K and L. (K) and (L) Widefield OCT images show staphyloma edge nasal to the optic disc (arrows). Serous retinal detachment is seen in the foveal region.

Figure 5.

Development of new staphyloma edges in eyes of the mature group. (A) Fundus photograph of the left eye of a 40-year-old woman with a refractive error of −12.0 diopters (D) and an axial length (AL) of 28.6 mm at the baseline. (B) Fundus photograph of the left eye 3.5 years later. The myopic refractive error has increased to −12.87 D and the AL increased to 28.8 mm. (C) Horizontal ultra-widefield optical coherence tomography (UWF-OCT) image across the fovea at the baseline. The scleral curvature is bowed posteriorly, however, there are no OCT features suggesting staphyloma edges. (D) Horizontal UWF-OCT image across the fovea at the final visit. A type 2 staphyloma edge with a choroidal “thick-thin-thick” pattern, inward scleral protrusion, and slight protrusion of the overlying retinal pigment epithelium can be seen temporal to the macula. (E) Fundus photograph of the left eye of a 44-year-old woman with a refractive error of −13.375 D and an AL of 30.8 mm at the baseline. (F) Fundus photograph of the left eye 4.4 years later. The myopic refractive error increased to −14.25 D and the AL increased to 30.9 mm. (G) Vertical UWF-OCT across the fovea at baseline. Panel I shows a magnified image. There are no OCT features suggesting staphyloma edges. (H) Vertical UWF-OCT section across the fovea at the final visit. Panel J shows a magnified image. An inward protrusion of sclera suggesting a staphyloma edge has formed.

Figure 6.

Progression of a staphyloma edge during the follow-up period. (A) Fundus photograph of the right eye of a 49-year-old woman at the baseline with a refractive error of −12.75 diopters (D) and an axial length (AL) of 30.1 mm showing a scarred macular neovascularization (MNV) with pigmentation. (B) Fundus photograph of the same eye 3.1 years later. The refractive error did not change but the AL increased to 30.3 mm. Macular atrophy developed around the scarred MNV. (C) Oblique ultra-widefield optical coherence tomography (UWF-OCT) image across the fovea at the baseline shows a slight and gradual protrusion of the sclera superior to the macula suggesting a type 1 staphyloma edge (arrow). MNV is also seen. (D) Oblique UWF-OCT image at the final visit shows an increased protrusion of the staphyloma edge (arrow). Retinoschisis is also present in the lower fundus.