Subretinal neovascularisation in eyes with localised inferior posterior staphylomas.

Abstract

SUMMARY We report seven cases of subretinal neovascularisation with inferior posterior staphyloma. The upper border of the shallow staphyloma, detected by B-mode echography, invaded the macular area, and there was a neovascular net at the edge of the staphyloma. Three of the cases showed chorioretinal atrophy at the upper edge of the staphyloma in the same location as the neovascular net. Our cases were identical to those of subretinal neovascularisation in high myopic eyes in which the rupture of Bruch's membrane was related to the deformity of the scleral shell. As our cases included not-high-myopic eyes, the results suggest that the identical mechanism might be involved in the occurrence of neovascular maculopathy in the pathological high myopic eye and in the not-high-myopic eye with posterior staphyloma. Localised inferior posterior staphyloma may be an important cause of 'idiopathic' subretinal neovascularisation.Subretinal neovascularisation is triggered by the rupture of Bruch's membrane in the posterior fundus. ' High myopia has been described as a cause of subretinal neovascularisation,2 as have aging, trauma, uveitis, angioid streaks, and macular dystrophies. In the high myopic eye the uvea and retina at the posterior fundus expand so that the axial length of the eye is elongated. This condition leads to the rupture of Bruch's membrane and the growth of subretinal neovascularisation.1 However, when a localised posterior staphyloma exists, the posterior fundus may expand somewhat without significant elongation of the axial length. For example, the tilted disc syndrome is not necessarily associated with high myopia but has the typical high myopic fundus in the lower half of the eye related to the inferior staphyloma.45 In such a case myopic pathological complications may occur inside the posterior staphyloma even if the eye is not high myopic.We report here a series of consecutive cases with subretinal neovascularisation that are not severely high myopic but have inferior posterior staphylomas in order to study the relationship between the inferior staphyloma and subretinal neovascularisation.Correspondcncc to Shunji Tsuboi, MD,

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

“…The authors hypothesised that in each case, the sharp change in contour seen at the upper edge of the staphyloma may cause localised chorioretinal degeneration with secondary disruption of Bruch's membrane and subsequent CNV when the macular area is involved. 3 Quaranta et al 4 reported one case where multiple choroidal neovascular membranes developed along the inner edge of a macular staphyloma with pigmentary disturbance and focal chorioretinal atrophic patches in the macular region in a patient with pathological myopia. Based on this observation, the authors suggested that the edge of a staphyloma where the choriocapillaris is well preserved was an important transitional zone associated with an increased risk of chorioretinal changes and choroidal neovascular membrane formation.…”

Chorioretinal degenerative changes in the tilted disc syndrome

“…Probably in this area there is a greater stretching of choroid and retina which promotes the development of the atrophy. Moreover, it has been suggested that choroid and retina when bending abruptly on the edge of the ectasia can became involved in local degenerative processes which may lead to the choroidal neovascularization [15].…”

“…This complication was already described in some patients with tilted disc syndrome [4,7,12,14,15] and it generally develops in the inferotemporal edge of the ectasia. It is possible, as has already been noted, that in this area marked alterations of retinal pigment epithelium, Bruch's membrane and choriocapillaris are produced, thus promoting the development of choroidal neovascularization [12,15]. Moreover, at least in some patients, it is possible that this complication is an age-related disciform macular degeneration, rather than a neovascularization secondary to the myopic astigmatism of the fundus.…”

Ranibizumab in the treatment of choroidal neovascularization on the border of an inferior staphyloma associated with tilted disc syndrome

“…In addition, an inferior staphyloma is often associated with this syndrome and severe complications such as choroidal neovascularization (CNV) can occur when the border of the staphyloma lies across the macula 4–7. This CNV usually shows a classic pattern on fluorescein angiography (FA) resulting in significant visual loss.…”