Retinal pigment epithelial changes and choroidal neovascularisation at the edge of posterior staphylomas; a case series and review of the literature

Abstract

Purpose To report five myopic patients who presented with a variety of changes at the edge of posterior staphyloma. Methods Retrospective, observational case series. The clinical and angiographic records of five patients who showed changes at the edge of posterior staphyloma were reviewed. One of these patients had been referred querying macular dystrophy. Results On fundus examination, three patients showed retinal pigment epithelial (RPE) changes at the edge of the staphyloma and two showed RPE atrophy with surrounding haemorrhages. Fluorescein angiography revealed areas of hyperfluorescence at the point of change of curvature of the staphyloma suggestive of RPE atrophy in all patients. In two patients, a choroidal neovascular membrane was seen. Indocyanine green angiogram carried out in one patient showed the presence of an occult choroidal neovascular membrane with preservation of the adjacent choriocapillaris. Conclusion This case series illustrates the variety of changes that can occur at the edge of posterior staphylomas, which ranged from RPE disturbance to choroidal neovascular membrane formation. In one of the patients, these changes were mistaken for macular dystrophy. Our observations also support the hypothesis that chorioretinal changes occur at the edge of staphylomas and may predispose to choroidal neovasularisation. Eye (2006) 20, 150-153.

Anatomic Peculiarities Associated with Axial Elongation of the Myopic Eye

“…Scleral staphylomas are a feature of highly myopic eyes. They have been described as outpouchings of a circumscribed region of the posterior sclera [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ]. Scleral staphylomas show a relatively abrupt scleral thinning at the staphyloma edge; a pronounced de-arrangement of scleral collagen fibrils; a marked, segmentally accentuated, choroidal thinning, most marked at the staphyloma border; and spatially correlated BM defects.…”

Dark adaptation changes in highly myopic patients

“…It may be accompanied by retinal changes essentially affecting the posterior pole, such as retinal pigment epithelium (RPE) atrophy, choroidal atrophy and retinal thinning. 1 These complications are related to the abnormal AL of highly myopic (HM) eyes and the development of posterior staphyloma. 2 Moreover, HM patients often complain of impaired night vision.…”

Spectral Domain Optical Coherence Tomography Analysis of Macular Changes in Tilted Disk Syndrome

“…This anomaly is probably because of delayed closure of the embryonic optic fissure that normally occurs during the fifth week of intrauterine life. 1,2 Many complications associated with tilted disk syndrome have been reported, and they were frequently localized at the upper edge of the staphyloma, in the area of transition between the part of the eye with a normal curvature and the part with a more important curvature that corresponds to the staphyloma area: retinal pigment epithelial changes, 6,7 choroidal neovascularization (CNV), [8][9][10] polypoidal choroidal vasculopathy, 11,12 and serous retinal detachment isolated or associated with leakages similar to those observed in central serous chorioretinopathy. [3][4][5] Many associated anomalies can be observed also at the level of the optic nerve or of the posterior pole: situs inversus, in which the retinal vessels emerge from the optic nerve in a nasal direction before turning toward the temporal side of the fundus, peripapillary crescent, staphyloma, and chorioretinal thinning, localized in the inferior part of the fundus.…”