Explore the vast range of titles available.

Pathologic myopia (PM) is an ocular disorder characterized by a spherical equivalent (SE) of more than - 6.0 diopters (D) or by an axial length (AL) of more than 26.5 millimeters (mm). PM is associated with myopic maculopathy (MM). The ATN classification describes all the aspects of MM which regroups atrophic, tractional and neovascular consequences to the sclera, choroid and retina of highly myopic eyes. The advent of OCT allowed to define the ultrastructural characteristics of the tractional changes in MM, described by the term myopic traction maculopathy (MTM). They include foveoschisis/maculoschisis/retinoschisis (FS/MS/RS), retinal/foveal detachment (RD/FD), lamellar macular holes (LMH) and full-thickness macular holes (FTMH) with or without RD (MHRD). The MTM staging system (MSS) describes all foveal and retinal changes related to MTM and their natural history interpreting them as different stages of a single progressive disorder. The management of MTM can be just observation for the earliest cases with good vision or surgery for the severe stages with vision loss. There are two possible surgical approaches: ab externo, that acts on the alteration of the scleral shape and includes posterior scleral reinforcement and macular buckle. Ab interno, that targets the alteration of the foveal profile and consists in pars plana vitrectomy with removal of all the epiretinal tractions, maneuvers on the internal limiting membrane, and the use of intravitreal tamponade and laser. As they target two different sides of the same pathology, the two techniques have to be selected on the base of the MTM stage, single or combined.

PurposeThe aim of this study is to review anatomical and functional outcomes following macular buckling (MB) in high myopia and to compare such results with those obtained by pars plana vitrectomy (PPV).MethodsPubMed articles on MB in high myopia (2000–2016) were reviewed. Main outcomes included retinal reattachment and macular hole (MH) closure rates, resolution of myopic foveoschisis (MFS), and postoperative visual acuity.ResultsThirty-one articles included 16 in patients with retinal detachment due to MH (MHRD group), 11 in MFS with or without foveal detachment (MFS group), and 4 in MH patients with MFS (MH-MFS group). Surgical techniques mainly differed in the type of buckle, rectus muscles involvement, and concurrent PPV. In eyes with persistent MH, prognosis in the MHRD and MH-MFS groups differed between eyes receiving MB compared to PPV: functional outcome was markedly poorer and there was a higher risk of retinal redetachment associated with PPV. In the MSF group, secondary MHs were more likely to develop in eyes treated with PPV and internal limiting membrane peeling than those undergoing MB alone or combined with PPV. Retinal pigment epithelium changes, malpositioning, perforation, and choroidal detachment were the main complications.ConclusionsAlthough different approaches are used, complete resolution of foveoschisis, retinal reattachment, and MH closure seem to be achieved more frequently with MB than PPV.

Posterior staphyloma (PS) is considered the hallmark of pathologic myopia and is defined as an outpouching of a circumscribed portion of the eyeball with a radius of curvature smaller than that of the adjacent zone. Although more common in eyes with high myopia, it can affect those without it. The presence of PS is associated with a structurally and functionally worse course of high myopia that can lead to visual disability. Unfortunately, the pathogenesis of PS is unclear so far. Thus, due to the increasing prevalence of myopia which has been further exacerbated by the advent of COVID-19 lockdown, researchers are eager to elucidate the pathogenesis of pathologic myopia and that of its complications, especially PS, which will allow the development of preventive strategies. The aim of this work was to review the morphological characteristics of PS with emphasis on similarities with peripapillary staphyloma and to discuss the pathogenesis of PS considering recent suggestions about that of peripapillary staphyloma.

ObjectiveTo investigate the microvasculature and structural characteristics of the eyes of myopic patients and their association with posterior staphyloma (PS).MethodsThis was a retrospective, case-control study comprising of 106 eyes from 72 individuals. Using 1:1 matching of axial length (AL) of their eyes, patients were allocated into a PS group or no posterior staphyloma (NPS) group. All patients were examined using ultra-widefield fundus imaging, optical coherence tomography angiography, and ocular biometry to acquire microvasculature and microstructure parameters.ResultsThe anterior chamber depth (ACD) of the PS group was significantly different from that of the NPS group (3.56 mm vs 3.76 mm, P < 0.001), as was 1ens thickness (3.72 mm vs 3.57 mm, P = 0.005) and spherical equivalent (SE)(-10.11D vs -8.80D, P = 0.014). The PS group had reduced choriocapillaris flow, subfoveal choroidal thickness (SFCT), and a thinner retinal layer compared with the NPS group. No difference in retinal blood flow between the two groups was observed. The PS group exhibited a smaller disc area (15082.89 vs 17,043.32, P = 0.003) and angle α between temporal retinal arterial vascular arcades (113.29°vs 128.39°, P = 0.003), a larger disc tilt ratio (1.41 vs 1.24, P < 0.001) and parapapillary atrophy (PPA) area (13840.98 vs 8753.86, P = 0.020), compared with the NPS group. Multivariate regression analysis indicated that disc tilt ratio (P = 0.031) and SFCT (P = 0.015) were significant predictors of PS. In addition, PS (P = 0.049), AL (P = 0.003), corneal refractive power (P < 0.001), ACD (P = 0.022), relative lens position (P = 0.045), and disc area (P = 0.011) were significant predictors of SE.ConclusionsPS was found to be closely linked to a reduction in choriocapillaris perfusion and anatomical abnormalities including posterior and anterior segments. Furthermore, PS exacerbated the progression of myopia.

This study examined choroidal circulation in inferior posterior staphyloma (IPS) eyes using mean blur rate (MBR) and beat strength over MBR (BOM) from laser speckle flowgraphy. Eighteen eyes from 12 patients with treatment-naïve IPS were studied, including 9 eyes with subretinal fluid (SRF). The thinnest part of the choroid was identified via optical coherence tomography, and rubber bands were placed at bordering across the superior and inferior regions. MBR and BOM, indices of blood flow velocity and resistance, were measured and analyzed. The MBR ratio and the BOM ratio, both arbitrarily prepared markers to show greater circulatory characteristics of IPS in smaller values, were compared between eyes with and without SRF. On average, the inferior region had a lower MBR and a higher BOM than the superior region. Both the MBR and BOM ratios were smaller in IPS eyes with SRF than in IPS eyes without SRF (all: P  < 0.05). The inferior region had lower choroidal blood flow velocity and higher resistance than the superior region in IPS. Greater circulatory characteristics of IPS were observed in eyes with SRF, suggesting that SRF was driven by the unbalanced distribution of choroidal blood flow.

Inferior posterior staphyloma (IPS) is a rare disease typically associated with tilted disc syndrome, characterized by posterior staphyloma within the inferior fundus, without pathological myopia. Subretinal fluid (SRF) occurs in about 30–40% of IPS cases. This study investigated choroidal circulation and morphological changes in IPS using widefield indocyanine green angiography (ICGA). The study included 14 eyes of 8 Japanese patients (mean age: 65.1 years) with treatment-naïve IPS and utilized ICGA and optical coherence tomography. Exclusion criteria were high myopia, macular diseases, prior treatments, and contrast media allergy. The main ICGA findings were a downward shift of the watershed (85.7% of eyes), asymmetric dilated vortex vein (ADVV) (85.7%), anastomosis between the superior and inferior choroidal veins (57.1%), and delayed choroidal filling (100%). SRF was present in seven eyes. No statistical differences were found in the ratio of downward shift, ADVV, or delayed filling between eyes with or without SRF. However, anastomosis was significantly higher in eyes without SRF. The study concluded that IPS shows high prevalence of watershed shift, ADVV, anastomosis, and choroidal filling delay, with anastomosis potentially resolving SRF by reducing choroidal blood flow congestion, similar to pachychoroid spectrum diseases. Key messages What is Known Inferior posterior staphyloma (IPS) sometimes occurs subretinal fluid (SRF), however the mechanism of its appearance and disappearence is unknown. What is new Indocyanine green angiography (ICGA) findings in IPS showed the downward shift in the watershed, asymmetric dilated vortex vein (ADVV), and choroidal filling delay, which was also found in pachychoroid spectrum diseases (PDS). Anastomosis between the superior and inferior choroidal veins across watershed contributes to the resolution of SRF in that it reduces the overload as the anastomosis progresses. We suggest that the mechanism for the appearance and disappearance of SRF in IPS may be due to the same mechanism that an imbalance in macular choroidal blood flow and localized hyperperfusion as in PDS.

Myopic eyes combining gamma peripapillary atrophy and peripapillary staphyloma were sorted according to the presence of intrachoroidal cavitation (PICCs) or its absence (combinations). Visual field defects (VFDs) and factors discriminating these groups were analyzed. These groups were sorted by optical coherence tomography. VFDs were assessed using the Humphrey Field Analyzer 3, SITA standard. Ovality index (OI) was the ratio between the shortest and longest diameters of the disc. The proportions of PICCs, lamina cribrosa defects (LCDs) and clusters in each Garway-Heath's sector (A-F) were analyzed. All variables were compared between PICCs and combinations. A multivariate logistic regression analysis was performed ultimately. Of the 93 eyes, we obtained, 20 PICCs and 73 combinations. The prevalence of VFDs and LCDs in PICCs were 65% (13/20) and 30% (6/20), respectively. PICCs 85% (17/20) and LCDs 12% (11/93) predominated in sector B (inferotemporal) and clusters 9.7% (9/93) in the corresponding sector. The proportion of VFDs was significantly higher in PICCs than combinations ( ). In sector B, the proportion of LCDs was significantly higher in PICCs than combinations ( ). The mean OI was significantly lower ( ) in PICCs than combinations. Multivariate logistic regression analysis concluded that mean OI ( ) was the only statistically significant factor discriminating PICCs and combinations. Mean OI discriminating PICCs from combinations is further evidence of a gradation of structural changes between them. It could be related to the higher proportion of VFDs in PICCs. The predominant distribution of PICCs infero-temporally supports PICC as a cause of uncertainty in glaucoma diagnosis in high myopia. Furthermore, the highest proportion of PICCs and LCDs in this sector highlights its vulnerability to damage in myopic eyes and deserves further investigation as it is also primarily involved in glaucoma.

Background To assess the rate of macular blood flow decreasing in adults with and without posterior staphyloma (PS) using optical coherence tomography angiography (OCTA) and to identify risk factors associated with PS progression. Methods This longitudinal case-control study enrolled 122 eyes of 122 patients—64 patients with PS (PS group) and 58 patients without PS (NPS group). Participants underwent OCTA and clinical examinations at least twice, and those followed for at least one year were included in the analysis. Logistic regression analysis and machine learning were applied to explore the risk factors for PS and its progression. Results Patients in the PS group exhibited faster growth rates of spherical equivalent refraction (SER), axial length (AL), curvature index (CI), and posterior scleral height (PSH) as well as higher loss rates of choriocapillaris perfusion area (CCPA), choroid perfusion area (CPA) and choroidal vascularity index (CVI) compared to the NPS group (all P  < 0.05). The baseline SER (B =  − 1.291, OR = 0.275, P  = 0.008), baseline subfoveal scleral thickness (B =  − 1.621, OR = 0.198, P  = 0.046), baseline PSH (B = 2.959, OR = 19.282, P  = 0.001) and foveal CVI changes per year (B =  − 2.776, OR = 0.062, P  < 0.001) were the risk factors for PS. Baseline AL (B = 0.561, OR = 1.752, P  = 0.033), parafoveal choroidal thickness changes per year (B =  − 0.094, OR = 0.910, P  = 0.032), foveal retinal vascular density changes per year (B = 0.104, OR = 1.110, P  = 0.013) and foveal CCPA changes per year (B =  − 0.214, OR = 0.807, P  = 0.038) were the risk factors for the PS progression. Conclusions During the progression of myopia in adults, changes in the morphology of the eye's posterior pole are not limited to axial lengthening alone; there also will be a phase of compensatory lateral expansion. Baseline AL and changes in the microcirculation can be utilized to predict the progression of PS.