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Olivier Lichtwitz, Sahbi Rouissi, Michèle Boissonnot, Pierre Ingrand, Nicolas Leveziel; Prevalence of macular complications associated with high myopia: a prospective study in a clinical setting. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5937.
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High myopia (HM) is a major cause of central visual loss worldwide. Chorioretinal complications related to HM include macular hemorrhage due to lacquer cracks, choroidal new vessels, dome-shaped macula and central chorioretinal atrophy, retinal foveoschisis and macular hole. The aim of this study was to describe the prevalence of macular complications in HM patients with VA decrease and to establish correlations between these complications and demographical or anatomical characteristics.
Prospective, monocentric study interventional study including HM patients without (group 1) or with (group 2) visual acuity decrease. Each patient underwent best corrected visual acuity, fundus examination, SD-OCT, and a fluorescein angiography (Heidelberg Retina Angiograph, Heidelberg, Germany) in case of myopic choroidal neovascularization or retinal macular hemorrhage possibly associated with myopic choroidal neovascularization. For each group, the presence of different anatomical criteria (posterior staphyloma, sub-foveal choroidal thickness) and the presence of macular complications (myopic choroidal neovascularization, lacquer cracks, central chorioretinal atrophy, dome-shaped macula, retinal foveoschisis and macular hole) were investigated.
87 eyes of 47 patients were included (48 eyes in group 1 and 39 eyes in group 2). A visual acuity decrease related to HM was due to a myopic choroidal neovascularization in 33% (n=16), to a macular hole in 25% (n=12), to a chorioretinal atrophy in 19% (n=9), to a foveoschisis in 11% (n=5), to a lacquer crack in 6% (n=3), to a dome-shape macula in 4% (n=2) and to an epiretinal membrane in 2% (n=1). After statistical analysis adjusted with the degree of myopia, the presence of staphyloma (p=0.016) and a higher choroidal thinning (p=0.045 by), the presence of chorioretinal atrophy (total p=0.00114) were still significantly associated with macular complications.
This study provides informations on the prevalence of macular complications responsible for vision decrease in HM. Although the degree of myopia is a major contributive factor for macular complications, the presence of a staphyloma, chorioretinal atrophy and choroidal thinning are predisposing factors for macular complications in this study. HM patients with staphyloma or choroidal thinning should benefit from comprehensive retinal screening for retinal complications.
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