LONGITUDINAL CHANGES OF POSTERIOR VORTEX VEINS IN HIGHLY MYOPIC EYES DETERMINED BY RETROSPECTIVE ANALYSES OF INDOCYANINE GREEN ANGIOGRAMS.

PURPOSE: To assess the longitudinal changes of the posterior vortex veins (VVs) in highly myopic (HM) eyes. METHODS: The medical records of 1,730 consecutive HM eyes that had undergone indocyanine green angiography were studied. Eyes that had posterior VVs and had undergone at least two indocyanine green angiography examinations with a minimum interval of 3 years were selected from this group. RESULTS: Ninety-one eyes of 78 patients met the inclusion criteria. A total of 124 posterior VVs were identified. Over an average interval of 7.8 ± 5.0 years, 41 (33.1%) of the 124 posterior VVs had marked changes consisting mainly of an attenuation of vessels in 36 posterior VVs (87.8%) and alterations in the drainage course in 16 posterior VVs (39.0%). Fifteen posterior VVs had both types of changes. Most of the attenuations of the vessels occurred for smaller branches, but a complete loss of the entire trunk was seen in three eyes. Additionally, four eyes had posterior VV changes in association with changes of peripheral VVs. CONCLUSION: Posterior VV in highly myopic eyes can undergo changes with increasing time. The associated factors included the development and progression of myopic maculopathy lesions. In some cases, the blood drainage shifted from posterior VV to peripheral VV by forming anastomotic channels.

COMPLEX HEMODYNAMICS OF INTERVORTEX VEIN ANASTOMOSES IN HIGHLY MYOPIC EYES.

PURPOSE: To analyze the complex pattern of filling of the intervortex vein (IVV) anastomoses through large trunks in highly myopic eyes based on indocyanine green angiographic (ICGA) videos. METHODS: The medical records of 1,060 consecutive highly myopic eyes that had undergone ICGA were studied. IVV anastomoses were identified in the ICGA images, and the ICGA images and videos were analyzed comprehensively to characterize their hemodynamic features. RESULTS: Seven eyes with IVV anastomoses through large trunks were analyzed. In the ICGA videos of six eyes, laminar flow was observed in the IVV anastomotic vessels. The laminar flow started in the arterial phase in two eyes, with pulsatile fashion in 1 of them. The flow began in the early arteriovenous transition phase in four eyes. The laminar flow continued for a mean of 12.17 ± 3.06 seconds, and the remaining section was gradually filled slower than the surrounding veins. The anastomotic trunk for the remaining one eye was too narrow to be analyzed. Four eyes had longitudinal ICGA records, and two had significant attenuation and narrowing of the anastomotic vessels. CONCLUSION: The very early filling of part of the IVV anastomoses suggests that arteriovenous anastomoses are involved in the IVV of highly myopic eyes. However, this suggestion needs further study. There may be similar pathogenesis for IVV anastomoses either in thick or thin sclera.

MORPHOLOGIC CHARACTERISTICS AND PROGRESSION PATTERNS OF MACULAR NEOVASCULARIZATION-RELATED ATROPHY IN EYES WITH PATHOLOGIC MYOPIA.

PURPOSE: To investigate the development and progression patterns of macular neovascularization (MNV)-related atrophies in eyes with pathologic myopia. METHODS: Twenty-seven eyes of 26 patients with MNV followed from its onset to progression to macular atrophy were studied. A longitudinal series of autofluorescence and optical coherence tomography images were examined for the patterns of MNV-related atrophy. Changes in best-corrected visual acuity were determined for each pattern. RESULTS: The mean age was 67.2 ± 8.7 years. The mean axial length was 29.6 ± 1.5 mm. Three patterns of atrophy were identified: multiple-atrophic pattern, 63% of the eyes had small atrophies occurring at multiple sites around the MNV edge; single-atrophic pattern, 18.5% had atrophies occurring only on one side of the MNV edge; and exudation-related pattern, 18.5% had atrophy occurring within a previous serous exudation or hemorrhagic area and slightly away from the MNV edge. Eyes with atrophies in multiple-atrophic and exudation-related patterns progressed to large macular atrophies involving the central fovea and showed decrease in best-corrected visual acuity during the 3-year follow-up period. Eyes with single-atrophic pattern had a sparing of the fovea and had good recovery of the best-corrected visual acuity. CONCLUSION: There are three patterns of MNV-related atrophy in eyes with pathologic myopia with different courses of progression.

LONGITUDINAL STUDY OF CHANGES IN INNER SCLERAL CURVATURE PATTERNS AND DEVELOPMENT OF POSTERIOR STAPHYLOMAS IN HIGHLY MYOPIC EYES OF CHILDREN AND ADOLESCENTS.

PURPOSE: To determine the longitudinal changes in patterns of inner scleral curvature and development of posterior staphylomas in the eyes of highly myopic youths. METHODS: A retrospective, longitudinal study. Ultra-widefield optic coherence tomographic (UWF-OCT) images from 47 eyes of 24 highly myopic patients with a follow-up period of 2 to 4 years were analyzed. Patients were divided into two groups, the children group younger than 10 years and the adolescents group aged 11 to 19 years. RESULTS: During the follow-up period, the scleral curvature patterns changed in either the horizontal or vertical optical coherence tomographic sections in 27 of the 46 eyes (58.7%) of both groups. The changes were significantly more frequent in children than adolescents. The change in the vertical section from symmetrical to asymmetrical in almost of children was correlated with an increase in the axial length and myopia. Four eyes had a staphyloma at the baseline. The staphyloma developed in six eyes of the remaining 43 eyes (14%). All staphyloma edges were found at or around the optic disc and were oriented in the horizontal direction. CONCLUSION: Our results showed that UWF-OCT images can be used to determine the process of new staphyloma formation and concurrent changes in scleral curvature patterns.

EXTREME MACULAR SCHISIS-SIMULATING RETINAL DETACHMENT IN EYES WITH PATHOLOGIC MYOPIA.

PURPOSE: To determine the clinical and imaging characteristics, natural course, and surgical outcomes of pathologic myopic eyes with an extreme macular schisis simulating a retinal detachment (EMSSRD). METHODS: The data of 617 highly myopic eyes with myopic traction maculopathy were studied. The diagnosis of EMSSRD in the optical coherence tomography images was made based on a high elevation of the retina (>500 µ m), less obvious columnar structures, and the presence of thin remnants of outer retinal tissues above the retinal pigment epithelium. RESULTS: Among 617 eyes, 25 eyes had an EMSSRD. All of the eyes with an EMSSRD had macular atrophy caused by myopic macular neovascularization. In the five eyes they had progressed to MHRD, the retinal detachment started away from the macular atrophy. Among the 10 eyes which required surgery, there was no significant difference in the presurgical and postsurgical best-corrected visual acuity between the eyes operated because of a worsening of the EMSSRD and the eyes operated because of a progression to MHRD. CONCLUSION: In severely myopic eyes with macular neovascularization-related macular atrophy, a novel condition termed EMSSRD can be present. The optical coherence tomography images resemble those of a MHRD except the presence of thin remnants of the retina remaining on the retinal pigment epithelium.

ANOMALIES OF CHOROIDAL VENOUS STRUCTURE IN HIGHLY MYOPIC EYES.

PURPOSE: To identify anomalies of choroidal venous structure in highly myopic (HM) eyes. METHODS: Widefield indocyanine green angiographic images of 175 HM eyes (refractive error ≤ -6.0D diopters or axial length >26.5 mm) and 100 control eyes taken between January 2014 and December 2018 were reviewed. RESULTS: There were no significant differences in age and gender between HM patients and controls. Three types of changes of large choroidal veins were found in 103 HM eyes (58.86%): Asymmetry of vortex veins in 44 eyes (25.14%), isolated long vein across the macula in 58 eyes (33.14%), and intervortex anastomoses in 25 eyes (14.29%). Similar changes in controls were found in 12 eyes (12%), 0 eye (0%), and 2 eyes (2%), respectively, which were significantly lower than those in the HM group (all P < 0.05). The patterns of asymmetry were affected by steeper staphyloma edges and anastomoses were observed through large trunks and terminal venules. In two eyes with large trunk anastomosis, attenuation of the less dominant vortex vein was observed afterward. CONCLUSION: Choroidal venous anomalies are more common in HM eyes than controls. Choroidal venous structure in HM eyes may be altering continuously, and such changes may underlie the development of myopic maculopathy.

Hospital-based study of risk factors associated with development of myopic macular neovascularization in highly myopic eyes.

INTRODUCTION: Myopic macular neovascularization (MNV) is the most common cause of a reduction of central vision in eyes with pathologic myopia, and it can progress to macular atrophy in the long-term. The aim of this study was to determine the risk factors associated with the development of MNVs. METHODS: There were 17,198 follow-up records from 5,409 eyes of 2,784 highly myopic patients that were reviewed. The general information and ophthalmic information in the records were studied. The significance of the correlations of factors associated with the development and predicting the development of myopic MNV were determined. RESULTS: Being a woman (odds ratio [OR]: 0.727, P<0.001), having a longer axial length (OR = 0.948, P<0.001), a poorer baseline best-correct visual acuity (BCVA, OR = 2.098, P<0.001), having severe myopic maculopathy (overall: P<0.001), prior myopic MNV in the fellow eye (OR = 4.105, P<0.001), presence of patchy atrophy (overall P<0.001), lacquer cracks (OR = 1.718, P<0.001), prior foveal retinal detachment (RD, OR = 3.269, P<0.001), prior macular hole (MH, OR = 0.641, P <0.001), prior macular retinoschisis (OR = 1.533, P<0.001), and prior macular edema (OR = 1.508, P<0.001) were significantly correlated with the development of myopic MNV. Eyes with MNV and patchy atrophy would require an intensive follow-up examination for myopic patients as the fellow eye would have a risk of >70% for the development of myopic MNV in 3-years and nearly 80% in 5-years. CONCLUSIONS: Clinicians need to pay special attention to eyes with severe grades of myopic maculopathy, prior myopic MNV in the fellow eye, presence of patchy atrophy, and prior foveal retinal detachment to determine the onset of myopic MNV.

Importance of Paravascular Vitreal Adhesions for Development of Myopic Macular Retinoschisis Detected by Ultra-Widefield OCT.

PURPOSE: To examine most postequatorial retina in eyes with myopic macular retinoschisis (MRS) by ultra-widefield (UWF) OCT and to determine whether paravascular vitreal adhesions play a role in the development of MRS. DESIGN: Retrospective single-center observational case series. PARTICIPANTS: One hundred fifty highly myopic participants who were older than 50 years with and without an MRS were studied. High myopia was defined as an eye with an axial length of more than 26.5 mm. METHODS: All participants underwent UWF OCT imaging with a scan width of 23 mm and a depth of 5 mm using a prototype swept-source OCT device. The vitreoretinal adhesions to the foveal retina and retinal vessels and paravascular abnormalities, including paravascular retinal cysts, paravascular retinoschisis, and paravascular lamellar holes, were analyzed in the UWF OCT images. The findings in eyes with an MRS were compared with those in eyes without an MRS. MAIN OUTCOME MEASURES: The relationships between MRS and vitreal adhesions to the retinal vessels or to the fovea were determined. RESULTS: An MRS was found in 49 of the 150 eyes (33%). Vitreal adhesions to the retinal vessels were found more frequently in eyes with an MRS than in eyes without an MRS (63% vs. 44%; P = 0.04). In contrast, the number of eyes with adhesions to the fovea in eyes with an MRS was not significantly different from that in eyes without an MRS (57% vs. 59%). Paravascular lesions, for example, retinal cysts, retinoschisis, and lamellar holes, were more common in eyes with an MRS than in eyes without an MRS (71% vs. 36%, 61% vs. 17 %, and 20% vs. 8% [P < 0.001, P < 0.001, and P = 0.03], respectively). Multivariate analysis showed that the presence of paravascular vitreal adhesions was a significant predictor for MRS development (odds ratio, 2.56; P = 0.02). CONCLUSIONS: Paravascular vitreal adhesions may be related to the development of the different types of paravascular lesions including retinal cysts and retinoschisis, and play a more important role in the development of an MRS than vitreal adhesions to the fovea.

CLINICAL FEATURES OF PATCHY CHORIORETINAL ATROPHY IN PATHOLOGIC MYOPIA.

PURPOSE: To reveal clinical features of patchy atrophy in pathologic myopia and investigate the status of the Bruch membrane and retinal pigment epithelium by swept-source optical coherence tomography. METHODS: This study reviewed highly myopic patients who visited the high myopia clinic between January 2015 and February 2018. Wide-field photographs and wide-field fundus autofluorescence fundus images were used as the primary method for identifying PAs, and swept-source optical coherence tomography images were used for investigating the retinochoroid status of PAs. RESULTS: Four hundred fifty-six PAs were detected in 137 eyes (118 patients). Patchy atrophys were located most often in the macular area (28.3%), followed by the inferior (25.9%), temporal (18.9%), nasal (14.5%), and superior (12.5%) region. All 210, PAs which had been fully or partially scanned by swept-source optical coherence tomography, showed a retinal pigment epithelium defect, and 174 (82.9%) PAs showed a Bruch membrane defect on the available scans. In 101 (82.8%) of 122 PAs with clearly detectable borders of the retinal pigment epithelium and Bruch membrane defect, the Bruch membrane defects were smaller than the retinal pigment epithelium defects. A dome-shape inward bulging of the sclera was observed in 10 PAs. CONCLUSION: These morphological findings may provide a basis for exploring the biomechanical etiology of the PAs as part of the development of pathologic myopia.

ABRUPTLY EMERGING VESSELS IN EYES WITH MYOPIC PATCHY CHORIORETINAL ATROPHY.

PURPOSE: To determine the prevalence and characteristics of abruptly emerging vessels (AEVs) within patchy atrophy (PA) in myopic eyes. METHODS: We studied 160 highly myopic eyes of 144 patients between March and November in 2016. Fundus photographs and swept-source optical coherence tomography images were analyzed. RESULTS: Patient mean age was 67.1 ± 10.5 years. Mean axial length was 30.9 ± 2.0 mm. The mean size of the 264 PAs was 5.6 ± 8.3 mm. Abruptly emerging vessels were detected in 69 (43.1%) eyes and were located within or near PA edge in fundus photographs. Swept-source optical coherence tomography showed that the AEVs were continuous with perforating scleral vessels and were observed on the inner surface of the sclera at the site where they appeared in fundus photographs. A slight bowing of sclera around the AEVs was observed in 41 (59%) eyes. Patchy atrophy with AEVs was significantly larger (10.7 ± 11.3 mm) than PA without AEVs (3.4 ± 5.1 mm). CONCLUSION: Abruptly emerging vessels are commonly found in eyes with myopic PA. The sclera surrounding the AEVs is slightly bowed. Further studies are needed to determine whether the penetrating site of AEVs is structurally more fragile and leads to Bruch membrane defects or AEVs are secondarily involved during PA progression.

DEVELOPMENT OF MACULAR ATROPHY AFTER PARS PLANA VITRECTOMY FOR MYOPIC TRACTION MACULOPATHY AND MACULAR HOLE RETINAL DETACHMENT IN PATHOLOGIC MYOPIA.

PURPOSE: To determine the incidence and long-term outcome of macular atrophy (MA) after pars plana vitrectomy (PPV) in pathologic myopia. METHODS: Highly myopic patients who underwent PPV for myopic traction maculopathy and macular hole retinal detachment at Tokyo Medical and Dental University between 2012 and 2016 were studied. Fundus photographs and/or optical coherence tomography were examined before and after PPV at every visit. RESULTS: A total of 133 eyes were followed for 39 months with the mean age of 62.8 years and the mean axial length of 30.0 mm. Postoperatively, 14 eyes (10.5%) developed fovea-centered MA, observed initially as a small, isolated, whitish lesion at the center of fovea at 3.5 months after PPV. The appearance of the MA was distinctly different from the choroidal neovascularization-related MA or patchy atrophy-related MA. With time, the lesions enlarged circumferentially. In these 14 eyes, the final best-corrected visual acuity was worse than the baseline, although the difference was not significant. The occurrence of MA was significantly associated with the preoperative foveal status. CONCLUSION: The development of MA can occur in 11% of highly myopic eyes after PPV for myopic traction maculopathy and macular hole retinal detachment. This postoperative MA might be a new complication of pathologic myopia.

RIDGE-SHAPED MACULA IN YOUNG MYOPIC PATIENTS AND ITS DIFFERENTIATION FROM TYPICAL DOME-SHAPED MACULA IN ELDERLY MYOPIC PATIENTS.

PURPOSE: To assess and compare clinical features of a ridge-shaped macula (defined as macular elevation only in one meridian across the fovea) in individuals younger than 20 years with those of a dome-shaped macula (DSM) in patients aged 20+ years. METHODS: The retrospective observational case series study included 185 highly myopic eyes of 100 consecutive patients younger than 20 years, who were compared with highly myopic patients with DSMs, aged 20+ years and examined in previous studies. RESULTS: Seventeen (9.2%) eyes of the highly myopic young patients showed macular elevations all of which ran only in the horizontal direction across the vertical optical coherence tomographic section fulfilled the definition of a ridge and did not show any staphylomas or any macular Bruch membrane defects. By contrast, in the older patients with DSMs, the DSMs were significantly higher and had a narrower base than the ridges in the young patients, and showed macular Bruch membrane defects in their vicinity, with the axial length being significantly longer, the myopic maculopathy more severe, and the subfoveal choroid thinner. CONCLUSION: Macular elevations detected in children and adolescents are usually ridge-shaped maculas and do not have the characteristics of DSMs. In comparison with DSMs, ridge-shaped maculas do not show a spatial association with macular Bruch membrane defects or posterior staphylomas and have a wider basis and smoother elevation slope. As a hypothesis, ridge-shaped maculas may be due to a folding of Bruch membrane at the posterior pole, potentially caused by an asymmetrical enlargement of Bruch membrane in the equatorial region.

RIDGE-SHAPED MACULA PROGRESSING PARALLEL TO BRUCH MEMBRANE DEFECTS AND MACULAR SUPRACHOROIDAL CAVITATION.

PURPOSE: To report on a progressing ridge-shaped macula parallel to Bruch membrane defects and a macular suprachoroidal cavitation. METHOD: Single case report. RESULT: The right eye of a 54-year-old man with an axial length of 30.96 mm showed 2 extrafoveal Bruch membrane defects with a partial herniation of the retina into the choroidal space and an ophthalmoscopically yellowish area inferior to one of the Bruch membrane defects. Optical coherence tomography revealed a horizontal transfoveal ridge of the sclera, Bruch membrane, and macula and a deepening of the suprachoroidal space, corresponding to the ophthalmoscopically detectable yellowish area and fulfilling the criteria of a macular suprachoroidal cavitation. After a follow-up of 10 years, the height of the ridge increased parallel to a further deepening of the macular suprachoroidal cavitation and an increase in axial length by 0.67 mm. CONCLUSION: The findings support the notion of a progression of a ridge-shaped macula parallel to a further deepening of a macular suprachoroidal cavitation in an axially elongating eye.

CLINICAL FEATURES OF LACQUER CRACKS IN EYES WITH PATHOLOGIC MYOPIA.

PURPOSE: To analyze the morphologic features of lacquer cracks (LCs), compare their detectability by different imaging instruments, and determine their progressive pattern. METHODS: The medical records of 47 highly myopic eyes of 33 patients with LCs were reviewed. Fundus fluorescein angiography was used as the primary method of identifying LCs, and the detection rate was compared with that by fundus autofluorescence and optical coherence tomography. RESULTS: A total of 176 LCs were detected in the 47 eyes. Lacquer cracks were detected more frequently in the temporal (44.3%) than the inferior (30.7%), superior (17.0%), and nasal (8.0%) quadrants of the retina. The detection rate of LCs was 98% in fundus photographs and 85% by fundus autofluorescence and optical coherence tomography. A progression of the LCs was observed in 22 of the 41 eyes with a follow-up period of ≥1 year. The progression patterns were an increase in the number (18 of 41, including 5 eyes in which new LCs had a branching pattern), elongation (4 of 41), and progression to patchy atrophy (6 of 41). CONCLUSION: Lacquer cracks can be detected noninvasively by fundus autofluorescence and optical coherence tomography; however, improvements are necessary to detect all of the lesions. Lacquer cracks frequently progress with time, and an increase in the number of LCs was the most frequent progression pattern.

FIVE-YEAR OUTCOMES OF INTRAVITREAL RANIBIZUMAB FOR CHOROIDAL NEOVASCULARIZATION IN PATIENTS WITH PATHOLOGIC MYOPIA.

PURPOSE: To determine the 5-year outcome of intravitreal ranibizumab (IVR) for myopic choroidal neovascularization (CNV). METHOD: We retrospectively analyzed the medical records of 51 eyes of 51 consecutive patients with myopic CNV who had been treated with IVR with a minimum follow-up period of 5 years after the initial IVR injection. The factors that predicted the best-corrected visual acuity (BCVA) at 5 years after IVR were determined by multiple regression analysis. RESULTS: The mean age of the subjects was 63.6 years, and the mean axial length was 29.4 mm. The mean number of IVR was 1.6, and 34 eyes (66.7%) had only a single IVR. At the baseline and at the 1-year, 2-year, 4-year, and 5-year period, the mean BCVAs were 20/49, 20/37, 20/41, 20/45, and 20/42, respectively. Stepwise multiple regression analysis showed that the BCVA at 5-year period was significantly correlated with the baseline BCVA, the number of IVR injections, and the size of the CNV-related macular atrophy. CONCLUSION: Intravitreal ranibizumab provide a 5-year visual benefit in eyes with myopic CNV compared with the natural course. A lack of enlargement of the CNV-related macular atrophy, a better baseline BCVA, and a minimum number of IVR injections were associated with better visual outcomes.

CORRELATIONS BETWEEN EXPERIMENTAL MYOPIA MODELS AND HUMAN PATHOLOGIC MYOPIA.

PURPOSE: To analyze the hallmark features of pathologic myopia developed in animal models and compare them with those seen in patients. METHODS: A literature review was performed to identify animal models that exhibited key features of pathologic myopia, namely posterior staphyloma, myopic maculopathy, lacquer cracks, and choroidal neovascularization, either spontaneously or induced by monocular deprivation. Using imaging modalities, such as optical coherence tomography, confocal scanning laser ophthalmoscopy, fluorescein angiography, and electron microscopy, these features were compared with those found in myopic maculopathy of patients. RESULTS: Three types of animals were identified. The LRP2 knockout mice exhibited posterior staphylomas and chorioretinal atrophy at 21 and 60 days after birth, respectively. Retinopathy globe enlarged (rge) chicks and normal lid-sutured chicks developed lacquer cracks and chorioretinal atrophy. Lacquer cracks detected in rge chicks subsequently progressed to patchy chorioretinal atrophy, which is also commonly seen in patients with pathologic myopia. CONCLUSION: The LRP2 knockout mice, retinopathy globe enlarged (rge) chicks, and normal lid-sutured chicks exhibit features typical for myopic maculopathy in patients and could serve to further elucidate the pathogenesis of myopic maculopathy.

Suprachoroidal hemorrhage followed by swept-source optical coherence tomography: a case report.

BACKGROUND: To report a case of Suprachoroidal Hemorrhage followed by Swept-Source Optical Coherence Tomography. CASE PRESENTATION: A 66-year-old woman with a rhegmatogenous retinal detachment in her left eye underwent pars plana vitrectomy. During the intraocular photocoagulation for a retinal tear after fluid-air exchange, a vitreous hemorrhage and suprachoroidal hemorrhage (SCH) developed. The surgical incisions were closed after filling the vitreous cavity with silicone oil. Two weeks later, the hemolyzed hemorrhage was removed, and new silicone oil was injected. After the surgery, a low reflective region was detected near the macula in the swept-source optical coherence tomographic (SS-OCT) images. The low reflective region was caused by the residual hemorrhage. The size of the reflective region gradually decreased and was not present at 3 months. We conclude that SS-OCT can be used to follow the resolution of a suprachoroidal hemorrhage. CONCLUSION: SS-OCT can be used to detect and follow the natural course of a suprachoroidal hemorrhage including the absorptive processes.

NEODYMIUM-DOPED YTTRIUM ALUMINUM GARNET LASER ABLATION OF INTERNAL LIMITING MEMBRANE TO TREAT MYOPIC MACULAR RETINOSCHISIS: CASE SERIES.

PURPOSE: To evaluate the efficacy and safety of neodymium-doped yttrium aluminum garnet laser ablation of the internal limiting membrane (ILM) to treat myopic macular retinoschisis. METHODS: Four patients with myopic myopic macular retinoschisis that extended out of the macular area were studied. All patients underwent yttrium aluminum garnet laser ablation of the detached ILM in the paramacular area, and the eyes were examined by ultra-widefield optical coherence tomography at the baseline and 6 months after the treatment. The measured outcomes were the foveal retinal thickness and the best-corrected visual acuity. RESULTS: Neodymium-doped yttrium aluminum garnet laser was applied to the paramacular ILM in all four eyes. In each eye, the procedure failed to disrupt the ILM, and no significant changes were observed in foveal retinal thickness or best-corrected visual acuity subsequently. No serious adverse event occurred in all eyes. A transient intraretinal hemorrhage developed at the site of the application in two eyes but resolved within a week after the treatment. CONCLUSION: Neodymium-doped yttrium aluminum garnet laser was applied to ILM in the peripheral macula in eyes with myopic macular retinoschisis. However, the lack of a reduction of the foveal thickness and improvement of the best-corrected visual acuity indicate that accurate focusing system is needed to treat eyes with myopic macular retinoschisis.

Polarization-Sensitive OCT Imaging of Scleral Abnormalities in Eyes With High Myopia and Dome-Shaped Macula.

Importance: The relevance of visualizing scleral fiber orientation may offer insights into the pathogenesis of pathologic myopia, including dome-shaped maculopathy (DSM). Objective: To investigate the orientation and density of scleral collagen fibers in highly myopic eyes with and without DSM by polarization-sensitive optical coherence tomography (PS-OCT). Design, Setting, and Participants: This case series included patients with highly myopic eyes (defined as a refractive error ≥6 diopters or an axial length ≥26.5 mm) with and without a DSM examined at a single site in May and June 2019. Analysis was performed from September 2019 to October 2023. Exposures: The PS-OCT was used to study the birefringence and optic axis of the scleral collagen fibers. Main Outcomes and Measures: The orientation and optic axis of scleral fibers in inner and outer layers of highly myopic eyes were assessed, and the results were compared between eyes with and without a DSM. Results: A total of 72 patients (51 [70.8%] female; mean [SD] age, 61.5 [12.8] years) were included, and 89 highly myopic eyes were examined (mean [SD] axial length, 30.4 [1.7] mm); 52 (58.4%) did not have a DSM and 37 (41.6%) had a DSM (10 bidirectional [27.0%] and 27 horizontal [73.0%]). Among the 52 eyes without DSM, the 13 eyes with simple high myopia had primarily inner sclera visible, displaying radially oriented fibers in optic axis images. In contrast, the entire thickness of the sclera was visible in 39 eyes with pathologic myopia. In these eyes, the optic axis images showed vertically oriented fibers within the outer sclera. Eyes presenting with both horizontal and bidirectional DSMs had clusters of fibers with low birefringence at the site of the DSM. In the optic axis images, horizontally or obliquely oriented scleral fibers were aggregated in the inner layer at the DSM. The vertical fibers located posterior to the inner fiber aggregation were not thickened and appeared thin compared with the surrounding areas. Conclusions and Relevance: This study using PS-OCT revealed inner scleral fiber aggregation without outer scleral thickening at the site of the DSM in highly myopic eyes. Given the common occurrence of scleral pathologies, such as DSM, and staphylomas in eyes with pathologic myopia, recognizing these fiber patterns could be important. These insights may be relevant to developing targeted therapies to address scleral abnormalities early and, thus, mitigate potential damage to the overlying neural tissue.

Characteristics and Prevalence of Staphyloma Edges at Different Ages in Highly Myopic Eyes.

Purpose: The purpose of this study was to determine the characteristics of staphyloma edges in highly myopic eyes and how they progress. Methods: We conducted a cross-sectional analysis using baseline data and a longitudinal study with follow-up data from 256 patients (447 eyes) with high myopia, with a mean (SD) follow-up of 3.79 (0.78) years. Participants were divided into four age groups: children (<13), youth (13-24), mature (25-59), and elderly (>60). Ultrawide-field swept-source optical coherence tomography was used to analyze staphyloma edges, which were divided into four areas: nasal to the optic disc (OD), superior to the macula, inferior to the macula, and temporal to the macula. Results: Staphylomas were significantly more prevalent in the mature (42.49%) and the elderly (51.35%) groups than in the children (13%) and youth (9%) groups. Staphyloma edges were predominantly superior to the macula in the mature and elderly groups. In contrast, staphylomas were rare in children and youth, with their edges mainly located nasal to the OD. The edges of staphylomas located superior and temporal to the macula were more likely to be associated with myopic traction maculopathy. During the follow-up period, 11 new staphyloma edges developed primarily in the mature group (64%). Additionally, 12 edges had an increased degree of protrusion over time, with most cases occurring in the mature (75%) group. Conclusions: The prevalence and location of staphyloma edges show significant variations depending on age. As time progresses, staphyloma edges manifest at distinct sites and increase their protrusion, potentially playing a role in the emergence of fundus complications.