Parapapillary Diffuse Choroidal Atrophy in Children Is Associated With Extreme Thinning of Parapapillary Choroid

Yokoi, Tae; Zhu, Dan; Bi, Hong; Jonas, Jost B.; Jonas, Rahul A.; Nagaoka, Natsuko; Moriyama, Muka; Yoshida, Takeshi; Ohno‐Matsui, Kyoko

doi:10.1167/iovs.16-20652

Cited by 32 publications

(19 citation statements)

References 25 publications

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“…The remaining 24 of the 48 eyes (50.0%) had a sudden and marked thinning of the choroid temporal to the optic disc (Fig 2). This finding was identical to what had been reported to be peripapillary diffuse chorioretinal atrophy (PDCA), [17, 18] which is a funduscopic feature of children that have a future progression to pathologic myopia as adults. However, in these 24 eyes, a scleral posterior displacement was not found (Fig 2).…”

Section: Resultssupporting

confidence: 88%

“…The results showed that the differences in the subfoveal retinal thickness and choroidal thicknesses (superior, inferior, temporal, nasal) between the eyes with and without a staphyloma were not significant. The lack of significant differences in the choroidal thickness nasal to the fovea between the eyes with and without a staphyloma may seem contradictory to the earlier study by Yokoi et al[18] Yokoi et al reported that myopic children with PDCA had significantly thinner choroid nasal to the fovea than control children in the Gobi Desert Children Eye Study. In contrast, the present study compared highly myopic children with and without a staphyloma.…”

Section: Discussionmentioning

confidence: 60%

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Posterior staphylomas and scleral curvature in highly myopic children and adolescents investigated by ultra-widefield optical coherence tomography

et al. 2019

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Purpose To determine the early signs of posterior staphylomas in highly myopic eyes of younger subjects by swept-source ultra-widefield optical coherence tomography (WF-OCT). Methods This was an observational case series study. Highly myopic subjects younger than 20 years old who were examined consecutively by prototype WF-OCT were studied. High myopia was defined according to the Ministry of Health and Welfare, Japan classification. A posterior displacement of the sclera and two OCT features indicating the staphyloma edges were used as markers of a staphyloma. Results Fifty-five eyes of 30 patients with the mean age of 12.3 years, and the mean axial length of 27.9 mm were studied. Seven of the 55 eyes (12.7%) had a posterior displacement of the sclera and were diagnosed as having a staphyloma. Among the two OCT features of the staphyloma edges, a gradual thinning of the choroid toward the staphyloma edge and gradual re-thickening of choroid from the staphyloma edge toward the posterior pole were found in these 7 eyes. However, the other feature of an inward protrusion of the sclera at the staphyloma edge, was obvious in only 2 eyes. The subfoveal choroid and choroid nasal to the optic disc were significantly thinner in eyes with a staphyloma than those without it. Conclusions The changes of the choroidal thickness toward the staphyloma edge with the posterior displacement of the sclera were considered an early sign which precedes an inward protrusion of sclera at the staphyloma edge.

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Section: Resultssupporting

confidence: 88%

Section: Discussionmentioning

confidence: 60%

Posterior staphylomas and scleral curvature in highly myopic children and adolescents investigated by ultra-widefield optical coherence tomography

et al. 2019

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“…30 On OCT images, PDCA in children is characterized by a profound and abrupt thinning of the choroid in the temporal parapapillary region. 289 The thinning of the choroid is abrupt and local; thus, it is critically different from a generalized impairment of choroidal circulation. Subsequently, Yokoi et al 289 also compared the OCT finding between a hospital-based group of highly myopic children with PDCA and a population-based control group of children.…”

Section: Key Oct Features Determining Pathologic Myopiamentioning

confidence: 99%

“…289 The thinning of the choroid is abrupt and local; thus, it is critically different from a generalized impairment of choroidal circulation. Subsequently, Yokoi et al 289 also compared the OCT finding between a hospital-based group of highly myopic children with PDCA and a population-based control group of children. It was shown that 76% of the PDCA group had a choroidal thickness at 2500 μm nasal to the foveola that was thinner than 60 μm, which was not found in the control group.…”

Section: Key Oct Features Determining Pathologic Myopiamentioning

confidence: 99%

IMI Pathologic Myopia

Ohno‐Matsui

Yamashiro

et al. 2021

Invest. Ophthalmol. Vis. Sci.

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192

159

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Pathologic myopia is a major cause of visual impairment worldwide. Pathologic myopia is distinctly different from high myopia. High myopia is a high degree of myopic refractive error, whereas pathologic myopia is defined by a presence of typical complications in the fundus (posterior staphyloma or myopic maculopathy equal to or more serious than diffuse choroidal atrophy). Pathologic myopia often occurs in eyes with high myopia, however its complications especially posterior staphyloma can also occur in eyes without high myopia. Owing to a recent advance in ocular imaging, an objective and accurate diagnosis of pathologic myopia has become possible. Especially, optical coherence tomography has revealed novel lesions like dome-shaped macula and myopic traction maculopathy. Wide-field optical coherence tomography has succeeded in visualizing the entire extent of large staphylomas. The effectiveness of new therapies for complications have been shown, such as anti-VEGF therapies for myopic macular neovascularization and vitreoretinal surgery for myopic traction maculopathy. Myopia, especially childhood myopia, has been increasing rapidly in the world. In parallel with an increase in myopia, the prevalence of high myopia has also been increasing. However, it remains unclear whether or not pathologic myopia will increase in parallel with an increase of myopia itself. In addition, it has remained unclear whether genes responsible for pathologic myopia are the same as those for myopia in general, or whether pathologic myopia is genetically different from other myopia.

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“…Peripapillary intrachoroidal cavitation (PICC) often appears in myopic eyes with β -PPA, and patients with PICC have larger β -PPA than those without PICC [ 21 ]. Furthermore, β -PPA in children is associated with extreme peripapillary thinning [ 22 ]. Chui and associates [ 23 ] reported that retinal stretching may not mirror scleral growth, and their results suggest that there could be slippage within the retina during eye growth.…”

Section: Discussionmentioning

confidence: 99%

Is the Retinal Vasculature Related to β-Peripapillary Atrophy in Nonpathological High Myopia? An Optical Coherence Tomography Angiography Study in Chinese Adults

Sun

Wang

You

et al. 2018

Journal of Ophthalmology

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Purpose The association between β-peripapillary atrophy and the retinal vasculature in nonpathological high myopia is unclear. The aim of this study is to investigate whether β-peripapillary atrophy contribute to the changes of the retinal vasculature using optical coherence tomography angiography. Methods In a cross-sectional study, one hundred and thirty eyes with nonpathological high myopia were included. β-peripapillary atrophy was analysed using Image J software based on fundus photographs. A 3.0 × 3.0 mm2 grid and a 4.5 × 4.5 mm2 grid were used to scan parafoveal and peripapillary regions using optical coherence tomography angiography, respectively. Vessel density and fractal dimensions of the retina and foveal avascular zone were analysed and quantified using en face projection images. Correlations between the vascular density, foveal avascular zone, and β-peripapillary atrophy were determined. Results Using multivariate analysis, β-peripapillary atrophy was negatively correlated with the vessel density in radial peripapillary capillaries (p=0.002) even after adjusting for other variables. This relationship was also confirmed in the macula (superficial retinal plexus: p < 0.05; deep retinal plexus: p < 0.05). The vessel densities in the nasal and inferior sectors were more strongly correlated with β-peripapillary atrophy. Conclusions There was a negative correlation between β-peripapillary atrophy and the retinal vasculature in highly myopic eyes, especially in radial peripapillary capillaries and deep retinal plexus. β-peripapillary atrophy can be visualized and is a convenient structural feature that can benefit the early diagnosis and detection of chorioretinal atrophy in high myopia.

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Parapapillary Diffuse Choroidal Atrophy in Children Is Associated With Extreme Thinning of Parapapillary Choroid

Cited by 32 publications

References 25 publications

Posterior staphylomas and scleral curvature in highly myopic children and adolescents investigated by ultra-widefield optical coherence tomography

Posterior staphylomas and scleral curvature in highly myopic children and adolescents investigated by ultra-widefield optical coherence tomography

IMI Pathologic Myopia

Is the Retinal Vasculature Related to β-Peripapillary Atrophy in Nonpathological High Myopia? An Optical Coherence Tomography Angiography Study in Chinese Adults

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