Complications associated with posterior staphyloma

Jung

2014

Eye

Purpose To determine the morphologic features of the optic disc and the location of visual field (VF) defect in relation to posterior staphyloma in normal tension glaucoma (NTG) eyes with myopia. Methods One hundred and thirty-four NTG patients with myopia were enrolled. B-scan ultrasonography was performed in enrolled patients. Disc tilt ratio, disc torsion, and area of peripapillary atrophy were measured from disc photographs. Patients were classified according to the presence of posterior staphyloma and its location: staphyloma involving the optic disc, staphyloma involving either the supero-temporal side of the optic disc or the infero-temporal side of the optic disc. The relationship between the location of the posterior staphyloma and that of the VF defect was analyzed. Results Among 134 eyes, 74 eyes (55.2%) had posterior staphyloma on B-scan ultrasonography. Mean torsion degree was significantly greater in eyes with staphyloma involving the temporal side of the optic disc (19.78±18.001) compared with eyes with staphyloma involving the optic disc (4.65±4.921, P ¼ 0.001). The frequency of the location of VF damage differed significantly between eyes with staphyloma involving the supero-temporal side and those involving the infero-temporal side of the optic disc (P ¼ 0.008), which was not significant in eyes with staphyloma involving the optic disc (P ¼ 0.813).Conclusions Optic disc torsion was a prominent finding in myopic NTG eyes when posterior staphyloma was located temporal to the optic disc. The location of posterior staphyloma was related to the direction of disc torsion and the location of VF defect.

Section: Introductionmentioning

confidence: 69%

Posterior staphyloma is related to optic disc morphology and the location of visual field defect in normal tension glaucoma patients with myopia

Jung

2014

Eye

“…Although there are some ocular conditions that may be associated with sustained static retinal stretch (e.g., high myopia, glaucoma) and can be associated with permeability and neovascular complications (91)(92)(93)(94)(95), the incidence of these complications is far less than for diabetic retinopathy.…”

Section: Stretch-and Hypertension-induced Retinal Vegf-r2 (Kdr) Exprementioning

confidence: 99%

Cyclic Stretch and Hypertension Induce Retinal Expression of Vascular Endothelial Growth Factor and Vascular Endothelial Growth Factor Receptor—2

et al. 2001

A single exposure to 20% symmetric static stretch increased KDR mRNA expression 3.9 ± 1.1-fold after 3 h (P = 0.002), with a gradual return to baseline within 9 h. In contrast, BRECs exposed to cardiac-profile cyclic stretch at 60 cpm continuously accumulated KDR mRNA in a transcriptionally mediated, time-dependent and stretchmagnitude-dependent manner. Exposure to 9% cyclic stretch increased KDR mRNA expression 8.7 ± 2.9-fold (P = 0.011) after 9 h and KDR protein concentration 1.8 ± 0.3-fold (P = 0.005) after 12 h. Stretched-induced VEGF responses were similar. Scatchard binding analysis demonstrated a 180 ± 40% (P = 0.032) increase in high-affinity VEGF receptor number with no change in affinity. Cyclic stretch increased basal thymidine uptake 60 ± 10% (P < 0.001) and VEGF-stimulated thymidine uptake by 2.6 ± 0.2-fold (P = 0.005). VEGFNAb reduced cyclic stretch-induced thymidine uptake by 65%. Stretched-induced KDR expression was not inhibited by AT1 receptor blockade using candesartan. Hypertension increased retinal KDR expression 67 ± 42% (P < 0.05) in SHR rats compared with normotensive WKY control animals. When hypertension was reduced using captopril or candesartan, retinal KDR expression returned to baseline levels. VEGF reacted similarly, but Flt expression did not change. These data suggest a novel molecular mechanism that would account for the exacerbation of diabetic retinopathy by concomitant hypertension, and may partially explain the principal clinical manifestations of hypertensive retinopathy itself. Furthermore, these data imply that anti-VEGF therapies may prove therapeutically effective for hypertensive retinopathy and/or ameliorating the deleterious effects of coexistent hypertension on VEGF-associated disorders such as diabetic retinopathy.

Invest. Ophthalmol. Vis. Sci.

“…1,4,5 Previous studies revealed that highly myopic eyes with posterior staphylomas had a significantly worse visual and anatomic outcome than highly myopic eyes without staphylomas. [6][7][8] Despite its importance, the description of posterior staphylomas has so far been based mostly on ophthalmoscopy. Based on their ophthalmoscopic appearance, Curtin 1 differentiated posterior staphylomas into 10 different types in 1977.…”

mentioning

confidence: 99%

Posterior Staphylomas in Pathologic Myopia Imaged by Widefield Optical Coherence Tomography

Shinohara

Shimada

Moriyama

et al. 2017

PURPOSE. To examine posterior staphylomas by widefield optical coherence tomography (WF-OCT) and three-dimensional magnetic resonance imaging (3D-MRI).METHODS. Highly myopic patients (myopic refractive error >8.0 diopters or axial length >26.5 mm) who had previously undergone orbital 3D-MRI were examined by WF-OCT. RESULTS.The study included 100 eyes of 57 patients with a mean age of 67.9 6 10.7 years (range, 44-85 years) and mean axial length of 30.0 6 2.3 mm (range, 25.1-36.5 mm). All staphylomas detected on the 3D-MRI, except for two very large staphylomas, were visualized on the WF-OCT images. Morphologic hallmarks of the staphylomas were smoothly configured staphyloma border with a gradual thinning of the choroid and an inward protrusion of the sclera at the staphyloma edge. Comparing the detectability of the staphylomas on the WF-OCT images versus 3D-MRI revealed no significant difference between both techniques (P ¼ 0.12; v 2 test). Comparing the staphyloma classification between both techniques showed a good concordance with a concordance index kappa of 0.61 (95% confidence interval: 0.50-0.72). A spatial relationship between the staphylomatous areas and the macula and optic nerve head was observed by WF-OCT.CONCLUSIONS. WF-OCT can provide tomographic images of posterior staphylomas in a resolution and size unachievable so far, and may replace 3D-MRI in assessing posterior staphylomas. Future studies using WF-OCT may explore the detailed morphologic characteristics of posterior staphylomas and give clues to the etiology of staphylomas.