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Suzanne Yzer, Jose P. Martinez, Sarah Mrejen, Camiel J F Boon, Roberto Gallego-Pinazo; Staphyloma-induced serous maculopathy . Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3852.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the clinical characteristics of posterior staphyloma associated with subfoveal fluid (SFF).
In an observational study we examined 6 patients (7 eyes) with posterior staphyloma and presence of subfoveal fluid (SFF) as detected by optical coherence tomography (OCT). All patients underwent a complete eye-exam including best-corrected visual acuity, slitlamp examination, dilated funduscopy, color fundus photography, fundus autofluorescence images, OCT and fluorescein- and indocyanine green angiography. Patients with choroidal neovascularization were excluded. In order to treat SFF patients were given intravitreal anti-VEGF injections, underwent photodynamic therapy or were given intramuscular octreotide injections.
All patients had suboptimal visual acuity ranging from 20/200 to 20/30. Refraction varied from emmetropia to pathologic myopia (SE -11,00 D). On funduscopy RPE changes, mainly hypopigmentation in the macula was clearly visible. The hypopigmentation appeared to follow the border of the staphyloma. On OCT SFF was visible, however both FA and ICG failed to show the cause of SFF. OCT showed an abrupt change in thickness of the choroid precisely on the edge of non-staphylomatous to staphylomatous curvature. SFF appeared to fluctuate over time but seemed unresponsive to treatments given.
This observational study showed that subretinal fluid was present on the edge of staphylomas. We hypothesize that the hypopigmentation on the border of staphylomas may be caused by stretching of the RPE, potentially affecting the function of the RPE, hence leading to subretinal fluid. All patients had a relatively thick choroid in the non-staphylomatous area possibly causative of SFF development in a similar fashion as observed in central serous chorioretinopathy. Also, the abrupt change in choroidal thickness on the transition side of non-staphylomatous to staphylomatous curvature may cause hydrostatic pressure of the choroid, potentially leading to the development of SFF. SFF in staphyloma-induced maculopathy may fluctuate and is refractory to known treatment strategies.
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