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Robert Beardsley, David Sarraf; Posterior Staphyloma and the Incidence of Macular Disease Imaged with SD-OCT. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3684.
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To assess the incidence and severity of macular disease (posterior vitreous detachment (PVD), vitreomacular traction (VMT), epiretinal membrane (ERM), macular schisis, lamellar macular hole, and full thickness macular hole (FTMH)) associated with posterior staphylomata in myopic eyes using high definition SD OCT imaging. Additionally, to correlate the presence of macular disease with the severity of posterior staphylomata using a novel a grading system based on posterior depth and arc of curvature.
A total of 150 eyes with posterior staphylomata involving the macula were imaged with the Cirrus SD-OCT (Carl Zeiss Meditec) system and were evaluated for the presence of PVD, VMT, ERM, macular schisis, lamellar hole, and FTMH. Each staphyloma was measured using the caliper tool and stratified into 5 grades with increasing depth as measured by the arc of curvature. The incidence of the various macular pathologies were correlated to each grade. Statistical analysis was done using Cochrane-Armitage Trend testing.
A total of 150 images were examined each of which had a posterior staphyloma. There were 60 with a depth of <500 microns (Grade 1), 63 with a depth of 500 to 999 microns (Grade 2), 23 with a depth of 1000 to 1499 microns (Grade 3), 1 with a depth of 1500 to 1999 microns (Grade 4), and 3 with a depth of greater than 2000 microns (Grade 5). The overall incidence of macular schisis was 20 % (25/150) and was significantly greater with Grade 2 (17.4%) and Grade 3 (34.8%) staphylomata versus Grade 1 staphylomata (8.3%) (p=0.008) indicating that the severity of posterior staphyloma increased the risk of development of macular schisis. The overall incidence of epiretinal membrane was 36% (54/150) and was greater in Grade 2 (44%) and Grade 3 (35%) versus Grade 1 (27%) though the trend failed to reach statistical significance (p=0.14). The incidence of VMT, lamellar hole, and FTMH similarly was increased in higher grade staphylomata though not significantly.
Imaging of staphylomata via high definition SD-OCT is a valuable tool for determining the severity of posterior staphylomata and for determining risk stratification for varying macular diseases. Increasing grade and severity of posterior staphylomata correlated to significantly increasing incidence of macular schisis and ERM. There was trend for increasing vitreomacular traction in association with ERM in eyes with macular schisis. We postulate that macular schisis may develop in eyes with more severe posterior staphyloma and progressive VM traction that may develop due to disproportionate anterior traction.
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