Ultra-Widefield Retinal Imaging for Analyzing the Association Between Types of Pathological Myopia and Posterior Staphyloma

Choroidal thinning in myopia is associated with axial elongation and severity of myopic maculopathy

High myopia can lead to pathologic myopia and visual impairment, whereas its causes are unclear. We retrospectively researched high myopia cases from patient records to investigate the association between axial elongation and myopic maculopathy. Sixty-four eyes were examined in patients who visited the department between July 2017 and June 2018, had an axial length of 26 mm or more, underwent fundus photography, and had their axial length measured twice or more. The average axial length was 28.29 ± 1.69 mm (mean ± standard deviation). The average age was 58.3 ± 14.4 years old. Myopic maculopathy was categorized as mild (grades 0 and 1) and severe (grades 2, 3, and 4). The severe group had longer axial lengths than the mild group (P < 0.05). Moreover, the severe group exhibited thinner choroidal thickness than the mild group (P < 0.05). When subjects were grouped by axial elongation over median value within a year, the elongation group showed thinner central choroidal thickness than the non-elongation group (142.1 ± 91.9 vs. 82.9 ± 69.8, P < 0.05). In conclusion, in patients with high myopia, the severity of maculopathy correlated with choroidal thickness and axial length. Thinner choroidal thickness was associated with axial elongation based on the baseline axial length.

Incidence and Risk Factors for Retinal Detachment Following Pediatric Cataract Surgery

Background

Retinal detachment is a major postsurgical threat in pediatric cataract surgery; however, the effect of axial length remains unclear. This study aimed to assess the relationship between axial length and detachment risk in vulnerable patients.

Methods

This retrospective cohort study analyzed 132 eyes of 84 pediatric cataract surgery patients aged <20 years old. Axial length was measured preoperatively, and the incidence of retinal detachment was recorded over a median follow-up of 4 years. Logistic regression analysis was used to examine the axial length-detachment relationship.

Results

Twenty eyes had postoperative retinal detachments. The median axial length was longer in the detachment group (23.6 mm) than in the non-detachment group (21.6 mm). Eyes with axial length ≤23.4 mm had 0.55-fold decreased odds of detachment compared to longer eyes. Preexisting myopia and glaucoma confer heightened risk. Approximately half of the patients retained some detachment risk eight years postoperatively.

Conclusion

Shorter eyes (axial length ≤23.4 mm) appear to be protected against pediatric retinal detachment after cataract surgery, whereas myopia, glaucoma, and axial elongation > 23.4 mm elevate the postoperative risk. Understanding these anatomical risk profiles requires surgical planning and follow-up care of children undergoing lensectomy.

What Should We Pay More Attention to Marfan Syndrome Expecting Ectopia Lentis: Incidence and Risk Factors of Retinal Manifestations

(1) Background: This paper investigates the incidence and risk factors of retinal manifestations in patients with Marfan syndrome (MFS) in a Chinese cohort. (2) Methods: This is a population-based cross-sectional study. In total, 344 eyes (172 MFS participants) were enrolled, each of whom underwent a detailed ocular examination. B-scan ultrasonography, ultra-wide-angle fundus images and optical coherence tomography images were conducted to assess posterior staphyloma, types of retinal damages and maculopathy. (3) Results: MFS patients have a high proportion (32.5%) of maculopathy, among which atrophy is the most common type (27.6%). Compared with participants without maculopathy, participants with maculopathy had a longer axial length (AL), higher incidence of posterior staphyloma, macular split and retinal detachment (RD) (p < 0.001, p < 0.001, p < 0.001 and p = 0.001). Moreover, the stage of RD has a significant correlation with longer AL and shallower anterior chamber depth (ACD) (p = 0.001 and p = 0.034, respectively). (4) Conclusions: A higher incidence and earlier onset of fundus lesions were found in MFS patients. Yearly systematic examination is recommended for MFS children with fundus manifestation until the cardiovascular and skeletal development is complete.

Investigation of Macular Structural and Microcirculatory Characteristics of Posterior Staphyloma in High Myopic Eyes by Swept Source Optical Coherence Tomography Angiography

Purpose: To investigate the characteristics of macular structures and microcirculation of posterior staphyloma (PS) and explored factors related to PS in eyes with high myopia.

Methods: There were 114 eyes of 82 patients in this study. Using 1:1 matching of the axial length of myopic eyes, patients were divided into no PS (NPS) and PS groups. Comprehensive ophthalmic examinations were performed on all patients. Structural parameters were acquired using swept source optical coherence tomography (SS-OCT). OCT angiography (OCTA) was used to measure the microcirculation parameters. Generalized estimated equation and linear correlation analysis were used for the statistical analysis.

Results: Patients with PS had a thinner retinal thickness (RT) and choroid thickness (CT) (all p < 0.05) in the measurement areas and a significantly lower subfoveal scleral thickness (SFST) (p < 0.001) than those without PS. Retinal deep vascular complex density (DVD) (all p < 0.05) and choriocapillaris perfusion area (CCPA) (all p < 0.001) were significantly lower in the measurement areas of the PS group than in those of the NPS group. There was no significant difference in the retinal superficial vascular density between the two groups. Generalized estimating equation indicated that SFST (B = 0.079, p = 0.001), parafoveal RT (B = −0.162, p = 0.041), foveal CT (B = 0.292, p = 0.013), parafoveal CT (B = −0.157, p = 0.023), foveal CCPA (B = 0.691, p = 0.003) and parafoveal CCPA (B = −0.026, p = 0.004) were significantly correlated with PS. Age (r = −0.323, p = 0.001), spherical equivalent refraction (SER) (r = 0.289, p = 0.004), subfoveal CT (r = 0.398, p < 0.001), foveal DVD (r = 0.346, p < 0.001), foveal CT (r = 0.429, p < 0.001), and foveal CCPA (r = 0.387, p < 0.001) were strongly correlated with SFST.

Conclusions: The macular structures and microcirculation in the PS group were different from those in the NPS group. SFST, CT, and CCPA were significantly correlated with PS. Lower SFST in PS was correlated with abnormalities of CT and microcirculation.

Factors Associated with Macular Staphyloma Area on Ultra-widefield Fundus Images

Purpose

To assess the feasibility of applying ultra-widefield fundus (UWF) images for macular staphyloma area (MSA) measurement and investigate the associated factors with MSA.

Methods

This is a retrospective study. MSA was measured by UWF imaging. Central foveal thickness, subfoveal choroidal thickness, subfoveal scleral thickness were measured on spectral domain optical coherence tomography. Intraclass correlation coefficients of MSA measurement would be evaluated. Multiple linear regression analysis was used to analyze the associated factors with MSA.

Results

In total, 135 eyes of 92 patients were enrolled. The mean age was 64.73 ± 10.84 years. Mean MSA on UWF image was 279.67 ± 71.70 mm². Intraclass correlation coefficients of MSA measurement was 0.965 (95% confidence interval [CI], 0.946 to 0.977; p < 0.001). In the multiple linear regression analysis, after adjusting for subfoveal choroidal thickness, best-corrected visual acuity, central foveal thickness, and subfoveal scleral thickness, the factors independently related to MSA were axial length (β = 8.352; 95% CI, 3.306 to 13.398; p = 0.001), sex (β = −26.673; 95% CI, −51.759 to −1.586; p = 0.037), age (β = 1.184; 95% CI, 0.020 to 2.348; p = 0.046).

Conclusions

It is feasible to measure MSA on UWF image. Female, longer axial length, and older age may indicate larger MSA.

Association Between Types of Posterior Staphyloma and Refractive Error After Cataract Surgery for High Myopia

Purpose: To investigate the association between different types of posterior staphyloma (PS) and refractive error (RE) after cataract surgery in patients with high myopia.

Methods: This retrospective study included 113 eyes of 113 highly myopic patients with PS. PS was detected using a wide-field fundus imaging system. PS was classified into wide macular, narrow macular, and other types. RE equaled the actual spherical equivalent (SE) minus the targeted SE values 3 months after cataract surgery.

Results: The rates of wide macular, narrow macular, and other types of PS were 46.02, 39.82, and 14.16%, respectively. There were no significant differences in best corrected distance visual acuity (BCDVA) or SE among the three classifications of PS before cataract surgery (P > 0.05). However, postoperative BCDVA and SE were significantly different among the three types of PS patients (P < 0.05). The average RE values were 0.98 ± 1.00 D, 0.19 ± 0.87 D, 0.13 ± 0.59 D, respectively; the statistical differences of RE were <0.01, <0.01, and 0.81 (wide macular vs. narrow macular, wide macular vs. other types, narrow macular vs. other types), respectively. Multivariate linear regression analysis revealed that higher hyperopia RE after surgery was associated with wide macular staphyloma (P < 0.001), more myopic SE (P = 0.003), and increased BCDVA (P = 0.002) before surgery.

Conclusions: Wide macular PS may be associated with more hyperopic RE; it may serve as a critical biomarker of hyperopic RE after cataract surgery in highly myopic patients.

Ultra-Widefield Imaging for Evaluation of the Myopic Eye

Topic: Ultra-widefield (UWF) imaging of the myopic eye. Clinical Relevance: Myopes, and particularly high and pathologic myopes, present a unique challenge in fundoscopic imaging. Critical pathology is often located in the anteriormost portion of the retina, variations in posterior segment contour are difficult to capture in two-dimensional images, and extremes in axial length make simply focusing imaging devices difficult. Methods: We review the evolution of modalities for ophthalmic imaging (color fundus photography [CFP], optical coherence topography [OCT], angiography, artificial intelligence [AI]) to present day UWF technology and its impact on our understanding of myopia. Results: Advances in UWF technology address many of the challenges in fundoscopic imaging of myopes, providing new insights into the structure and function of the myopic eye. UWF CFP improves our ability to detect and document anterior peripheral pathology prevalent in approximately half of all high myopes. UWF OCT better captures the staphylomatous contour of the myopic eye, providing enhanced visualization of the vitreoretinal interface and progressive development of myopic traction maculopathy. UWF angiography highlights the posterior vortex veins, thin choriocapillaris, far peripheral avascularity, and peripheral retinal capillary microaneurysms more prevalent in the myopic eye. Researchers have demonstrated the ability of AI algorithms to predict refractive error, and great potential remains in the use of AI technology for the screening and prevention of myopic disease. Conclusion: We note significant progress in our ability to capture anterior pathology and improved image quality of the posterior segment of high and pathologic myopes. The next jump forward for UWF imaging will be the ability to capture a high quality ora to ora multimodal fundoscopic image in a single scan that will allow for sensitive AI-assisted screening of myopic disease.