Influence of posterior staphyloma in myopic maculopathy and visual prognosis

Abstract Background/Objectives: Posterior staphyloma is a hallmark of high myopia and its presence associate higher degrees of myopic maculopathy, nevertheless it is still unclear its development, repercussion on visual function and relationship with maculopathy components. The objective was to analyze the impact of posterior staphyloma on the incidence and severity of myopic maculopathy and its repercussion on visual prognosis. Subjects/Methods: Cross-sectional study conducted in 473 consecutive eyes of 259 highly myopic patients examined at Puerta de Hierro-Majadahonda University Hospital (Madrid, Spain). All patients underwent complete ophthalmologic examination including best corrected visual acuity (BCVA), axial length (AL), ATN grading and multimodal imaging. Presence of posterior staphyloma, pathologic myopia (PM) and severe PM were determined. Results: Posterior staphyloma was present in 69.4% of eyes, 73.5% were categorized as primary according to Curtin’s classification. Eyes with posterior staphyloma compared to non-staphyloma were older (p<0.05), had greater AL (p<0.01), worse BCVA (p<0.01) and higher stage in ATN components (p<0.01). Moreover, compound subgroup showed worse BCVA (p<0.01) and greater stage in each of the ATN components (p<0.01). Staphylomas with macular involvement presented worse BCVA (p<0.01), higher AL (p<0.01), and greater ATN (p<0.05). The risk of posterior staphyloma presence in eyes with PM and severe PM eyes was 89.8% and 96.7%, respectively. Posterior staphyloma was the best predictor for BCVA in myopic patients (p<0.01). Conclusions: Posterior staphyloma presence determines high risk of myopic maculopathy and therefore worse visual prognosis, especially those with macular involvement. Posterior staphyloma represented the best predictor for BCVA in highly myopic patients.