Posterior staphyloma determines higher degrees of myopic maculopathy with worse visual acuity. Axial length and age are the main risk factors for posterior staphyloma development.

Posterior staphyloma determines higher degrees of myopic maculopathy with worse visual acuity. Axial length and age are the main risk factors for posterior staphyloma development. Photo: Andrew Rouse, OD. Click image to enlarge.

Posterior staphyloma has been shown to be associated with myopia maculopathy, but the exact relationship between the two hasn’t been established. In this study, researchers aimed to determine the influence of posterior staphyloma on the development of myopic maculopathy and found that posterior staphyloma is not only associated with myopic maculopathy but also worse visual acuity—which was shown to be the biggest risk factor—and a higher prevalence of severe posterior myopia.

A total of 467 highly myopic eyes of 246 patients were included and split into two groups, one with posterior staphyloma (n=325) and a control group. The team compared age, axial length (AL), best-corrected visual acuity, atrophy/traction/neovascularization (ATN) components and severe pathologic myopia. The control group was younger, had lower AL, ATN components and prevalence of severe pathologic myopia than those with posterior staphyloma. Additionally, the prevalence rate of severe posterior myopia was greater in the posterior staphyloma group.

Not all of the high myopia eyes developed posterior staphyloma, which shows the importance of analyzing the effect of the onset of posterior staphyloma on the development of myopic maculopathy and thus on the loss of visual acuity in high myopic patients, the authors wrote in their paper.

The study also showed that AL varied widely among the entire cohort, suggesting that it may not be the best indicator to characterize pathologic myopia.

“Although the importance of posterior staphyloma had been highlighted in previous research, in this study it was demonstrated to be the main factor involved in myopic maculopathy,” the authors concluded. “Consequently, before vision-threatening complications arise, prevention and treatment of the onset of posterior staphyloma would be desirable.”

Ruiz-Moreno JM, Puertas M, Flores-Moreno I, et al. Posterior staphyloma as determining factor for myopic maculopathy. Am J Ophthalmol. February 22, 2023. [Epub ahead of print].