Myopic maculopathy and posterior staphyloma. Correlation with ATN classification and severe pathological myopia

Abstract

AbstractPurpose: The aims of this study were: (1) to correlate posterior staphyloma with the ATN classification; (2) identify differences in clinical characteristics in terms of axial length (AL), age and best corrected visual acuity (BCVA) in eyes with the presence and absence of posterior staphyloma; (3) correlate the presence of posterior staphyloma with severe pathological myopia.Methods: This was a cross‐sectional and observational study developed in consecutive patients with high myopia. A complete ophthalmological examination, classification of myopic maculopathy according to the ATN grading system, staphyloma classification according to Curtin, and multimodal imaging tests (retinography, swept‐source OCT, autofluorescence and OCT‐angiography) were performed.Results: 336 eyes of 178 patients with high myopia were included. 71.4% of the sample were woman. The mean AL was 29.7 ± 2.6 mm (26–36.7). The mean age was 62.7 ± 13.1 years (27–92). The BCVA was 0.5 ± 0.3 (0–1). 238 eyes (70.8%) presented staphyloma; classifying 73.5% (n = 175/238) as simple and 26.5% as compound (n = 63/238). The most frequent types of staphylomas were type 2 and type 3, both present in 18.1% of the total (n = 43/238). Eyes with staphyloma had higher AL, worse BCVA and older age (p < 0.01), with no differences between sexes (p > 0.05). When differentiating between eyes with simple staphyloma and compound staphyloma, statistically significant differences were observed with respect to AL (p < 0.01), being higher in compound staphylomas. The severe pathological myopia subgroup (LA > 29.5 mm) presented a higher incidence of posterior staphyloma, with statistically significant differences (p < 0.01). Regarding the ATN classification, when analysing the eyes with the presence and absence of staphyloma, statistically significant differences (p < 0.01) were observed in the three components (atrophic [A], tractional [T] and neovascular [N]); having more advanced stages of A, T and N the eyes with staphyloma.Conclusions: Posterior staphyloma in highly myopic patients is a crucial finding in the progression of myopic maculopathy, being related to worse visual acuity, greater AL, older age and more advanced stages of the ATN classification. There is a higher prevalence of posterior staphyloma in eyes with severe pathological myopia.