The Importance of the Type of Posterior Staphyloma in the Development of Myopic Maculopathy

The objective of this paper was to determine how different types of posterior staphyloma (PS) may affect the appearance and degree of myopic maculopathy. A cross-sectional study was conducted, in which 467 eyes from 246 highly myopic patients [axial length (AL) >= 26 mm] were studied. A complete ophthalmic exploration was carried out on all patients, including imaging tests. The presence of macular PS was established as the main comparison variable between groups (macular PS vs. non-macular PS vs. non-PS). The variables analyzed included age, AL, decimal best-corrected visual acuity (BCVA), Atrophy (A)/Traction (T)/Neovascularization (N) components according to the ATN grading system, and the presence of severe pathologic myopia (PM). Out of the total, 179 eyes (38.3%) presented macular PS, 146 eyes presented non-macular PS (31.2%), and 142 eyes showed no PS (30.4%). The group without PS was significantly younger than macular PS and non-macular PS groups (53.85 vs. 66.57 vs. 65.20 years; p < 0.001 each, respectively). There were no age differences between PS groups. Eyes with macular PS (31.47 +/- 2.30 mm) were significantly longer than those with non-macular PS (28.68 +/- 1.78 mm, p < 0.001) and those without PS (27.47 +/- 1.34 mm, p < 0.001). BCVA was significantly better in the non-PS group (0.75 +/- 0.27) compared to the non-macular PS (0.56 +/- 0.31) and macular PS groups (0.43 +/- 0.33), with p < 0.001 each. Eyes without PS showed significantly lower A and T components (1.31 +/- 0.96 and 0.30 +/- 0.53, respectively) than non-macular PS (2.21 +/- 0.75 and 0.71 +/- 0.99, respectively, p < 0.001 each) and macular PS eyes (2.83 +/- 0.64 and 1.11 +/- 1.10, respectively, p < 0.001 each). The N component was lower in non-PS eyes vs. non-macular PS eyes (0.20 +/- 0.59 vs. 0.47 +/- 0.83, p < 0.001) and as compared to the macular PS group (0.68 +/- 0.90, p < 0.01). Additionally, the N component was significantly lower in the non-macular PS group than in the macular PS one (p < 0.05). The prevalence of severe PM was different between groups (p < 0.001). It was higher among macular PS eyes (138/179) when compared to other groups (p < 0.001, each), followed by the non-macular PS eyes (40/146) and being the lowest in the non-PS group (20/142). To conclude, macular PS is associated with a more advanced maculopathy, worse vision, and higher rates of severe PM.