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Influence of posterior staphyloma in myopic maculopathy and visual prognosis

Eye volume 38, pages 145–152 (2024)Cite this article

Subjects

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.

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Fig. 1: Color fundus photography showing different posterior staphyloma subtypes [20].
Fig. 2: Right high myopic eye with peripapillary subtype (type III) posterior staphyloma.

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Data availability

Most of the data analyzed during the study that support the findings are included in this published article. Further data are not publicly available due to privacy reasons but are available from the corresponding author upon reasonable request.

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Funding

Prof. José M. Ruiz-Moreno disclosed receipt of the following financial support for the research, authorship, and/or publication of this article from: Topcon, Co. The sponsor had no role in the design or conduct of this research.

Author information

Author notes

  1. These authors contributed equally: Ignacio Flores-Moreno, Mariluz Puertas.

Authors and Affiliations

  1. Puerta de Hierro-Majadahonda University Hospital, Majadahonda (Madrid), Spain

    Ignacio Flores-Moreno, Mariluz Puertas, Jorge Ruiz-Medrano, Elena Almazán-Alonso, María García-Zamora & José M. Ruiz-Moreno

  2. Clínica Suárez Leoz, Madrid, Spain

    Ignacio Flores-Moreno

  3. Miranza Corporation, Madrid, Spain

    Jorge Ruiz-Medrano & José M. Ruiz-Moreno

  4. Department of Ophthalmology, Castilla La Mancha University, Albacete, Spain

    José M. Ruiz-Moreno

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  1. Ignacio Flores-Moreno
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Contributions

IFM and MP were involved in research design, data acquisition, analysis, and interpretation; and drafted the final manuscript. IFM, MP, JRM, EAA, MGZ and JMRM made substantial contributions to the conception of the study, approved the final version and have agreed to be personally accountable for the author’s own contributions and to ensure that questions related to the accuracy or integrity of any part of the work.

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Correspondence to Mariluz Puertas.

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Flores-Moreno, I., Puertas, M., Ruiz-Medrano, J. et al. Influence of posterior staphyloma in myopic maculopathy and visual prognosis. Eye 38, 145–152 (2024). https://doi.org/10.1038/s41433-023-02648-z

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