Peripapillary Changes Detected by Optical Coherence Tomography in Eyes with High Myopia

Abstract

To investigate the morphologic alterations around the optic disc by optical coherence tomography (OCT) in eyes with high myopia. Observational case series. One hundred twenty-seven eyes (69 patients) with high (> or =-8.00 diopters [D]) myopia were included. In addition, 46 emmetropic (+1.00 to -1.00 D) eyes and 40 eyes with low (<-6.00 D) myopia were examined as controls. The participants had ophthalmologic examinations including stereoscopic fundus observations, OCT examinations, and perimetry. For OCT, multiple horizontal and vertical OCT scans were obtained around the optic disc and fovea in each patient. The presence of a peripapillary detachment in eyes with pathologic myopia (PDPM) around and within the area of myopic conus, and the vascular microfolds and retinoschisis at the site of the retinal vessels at the conus edge were evaluated. A PDPM was detected by OCT in 14 eyes (11.0%). A PDPM was seen in the OCT images as a hyporeflective space intrachoroidally and subretinally. Hyporeflective spaces resembling PDPMs were also observed within the tissue posterior to the conus in eyes without the typical ophthalmoscopic yellow-orange lesions. Eyes with PDPM had glaucomalike visual field defects more frequently than eyes without PDPM. Pitlike structures within the conus were observed ophthalmoscopically in 3 eyes with high myopia, and OCT examinations revealed the presence of cystic structures with an opening toward the vitreous cavity at the corresponding sites. Microfolds in the retinal vessels were detected at the conus edge in 58 of the highly myopic eyes (45.0%), and 28 of these eyes had retinoschisis at the site of the retinal vessels. Fifteen of these 28 eyes showed an extension of the retinoschisis along the temporal retinal vessels toward the macula, and 9 of these 15 eyes had myopic foveoschisis. None of these changes (PDPM, pitlike structures, microfolds, and retinoschisis) were detected in controls. The OCT examinations demonstrated different types of abnormalities around the optic disc in highly myopic eyes. These changes might be related to the visually disabling complications, such as visual field loss and myopic foveoschisis, seen in highly myopic eyes.