Posterior Staphyloma Predicts Myopic Maculopathy Risk, Visual Prognosis

The presence of a posterior staphyloma indicates a high risk of myopic maculopathy and serves as the best predictor for visual outcomes in individuals with high myopia (axial length ≥26 mm), according to a study published in Eye.

Researchers included 259 individuals with high myopia (eyes, 473; mean age, 62.4 years; 70.65% women) in the cross sectional investigation performed between June 2021 and June 2022. Study participants underwent best corrected visual acuity (BCVA) assessment, axial length measurements, multimodal imaging, and myopic maculopathy grading based on the atropic, tractional, and neovascular (ATN) component grading system.

The team stratified participants into 2 groups, consisting of individuals with high pathologic myopia (patchy chorioretinal atrophy or worse, foveal detachment, active myopic or scar choroidal neovascularization, scar or Fuchs spot, and axial length ≥29.5 mm) and patients with pathologic myopia. The investigators examined the effect of posterior staphyloma on myopic maculopathy incidence and severity among the cohort and its ability to predict visual outcomes.

Overall, posterior staphyloma was present in 69.4% of eyes. Compared with participants who did not have staphyloma, individuals with posterior staphyloma were older (P <.05), had longer axial length (P <.01), worse BCVA (P <.01), and higher stage ATN classifications (P <.01).

Posterior staphyloma with macular involvement was noted in 54.6% of the cohort, and these individuals had worse BCVA (P <.01), more advanced stages in each of the ATN components (P <.01), and longer axial length compared with the remainder of the cohort. Pathologic myopia had a 89.8% (95% CI, 86.1%-93.5%) positive predictive value for posterior staphyloma, and severe pathologic myopia had a 96.7% (95% CI, 93.6%-99.8%) positive value for staphyloma, according to the report.

“[Posterior staphyloma’s] presence determines high risk of myopic maculopathy and therefore worse visual prognosis, representing the best predictor for BCVA,” according to the study authors. “Posterior staphyloma should be considered practically as a constant hallmark of [pathologic myopia] and severe [pathologic myopia] determining the follow-up and prognosis of these patients.”

Study limitations include a single center design, the lack of a control group, and an inability to determine staphyloma depth due to a lack of ultra-wide-field optical coherence tomography (OCT) imaging.