1. The study examines vitreoretinal interface modifications in highly myopic eyes with posterior staphyloma over a 5-year follow up period.
2. 214 eyes were included and classified into 5 groups based on anatomical changes observed. The most common finding was epiretinal membrane without retinal changes (45.7% of eyes).
3. Evolution requiring surgery occurred in 11.7% of eyes, with various surgical approaches used depending on the classification group.
4. Vitreoretinal alterations in highly myopic eyes represent a spectrum of conditions that are not fully classified, and disease progression and surgical timing remain uncertain and need standardization.
2. 2
Modificazioni Vitreo-Retiniche negli
Stafilomi nel Miope Elevato ed Eventuali
Indicazioni Chirurgiche.
Guido Ripandelli
Tommaso Rossi*
Fabio Scarinci
Mario Stirpe
IRCCS ā Fondazione Bietti, Roma
*Ospedale Oftalmico, Roma
3. 3
Macular Vitreo-Retinal Interface
Abnormalities in Highly Myopic Eyes with
Posterior Staphyloma:
5-Years Follow-Up.
Guido Ripandelli, Tommaso Rossi, * Fabio Scarinci,
Cecilia Scassa, Vincenzo Parisi, Mario Stirpe.
Retina 2012;32:1531-8.
4. 4
ā¢ Purpose: to review prevalence, long-term
progression and prognosis of VR interface
modifications in highly myopic eyes with
posterior staphyloma
When surgery is necessary?
Which is the best timing for surgery?
ā¢ Study design: retrospective, single
Institution series
5. 5
Patientsā characteristics
ā¢ December 1999 - December 2004
ā¢ 408 phakic eyes / 204 subjects
ā¢ 108 Males / 96 Females
ā¢ Age 22-58 years
ā¢ Myopia 18-30 D and PS (Axial lenght 30-34
mm)
6. 6
Inclusion Criteria
ā¢ AL > 30 mm
ā¢ Presence of posterior staphyloma
ā¢ Availability of OCT, MP1 at baseline, at
latest examination, (before and after
surgery)
19. 19
PRD in the staphyloma area with macula on (PRD M-on)
11 eyes (5.1%)
Gr. 5 Posterior retinal detachment (PRD, 20 eyes)
20. 20
PRD in the staphyloma area with macula off (PRD M-off)
4 eyes (1.8%)
Gr. 5 Posterior retinal detachment (PRD, 20 eyes)
21. 21
PRD with macular hole (PRDMH)
5 eyes (2.3%)
Gr. 5 Posterior retinal detachment (PRD, 20 eyes)
22. 22
Evolution to pathologies requiring surgery: 24/205 (11.7%)
(9 PRD eyes underwent surgery upon presentation)
Gr. 1 Epiretinal membrane without retinal changes (EM) : 2/98 (2V)
Gr. 2 Asymptomatic macular schisis (AMSEM): 6/33 (3V, 3V+PB)
Symptomatic macular schisis (SMSEM): 7/14 (4V, 3V+PB)
Posterior stretch schisis (PSS): 0/7 -
Gr. 3 PTHM with macular schisis (PTMH-MS): 5/15 (3V, 2V+PB)
PTMH without macular schisis (PTMH-w/o MS): 0/9 -
Gr. 4 Asymptomatic macular hole (AFTMH): 2/9 (2V)
Symptomatic macular hole (SFTMH): 1/9 (1V)
Gr. 5 PRD in staphyloma area / macula ON (PRD M-on): 1/11 (1V)
PRD in staphyloma area/ macula off (PRD M-off): 4/4 (2V, 2V+PB)
PRD with macular hole (PRD-MH): 5/5 (2V, 3V+PB)
V= vitrectomy, PB= posterior buckle
23. 23
Observations
High myopia with posterior staphyloma
can be associated with a broad
spectrum of vitreoretinal alterations
and represents an elusive nosological
entity, whose natural history,
progression, therapeutic options and
surgical timing remain uncertain.
24. 24
Observations
ā¢ High myopic eyes with posterior staphyloma
show high frequency of vitreoretinal alterations
(57.8%)
ā¢ Bilateral vitreoretinal changes on 84.5% patients
ā¢ Anatomical changes and visual acuity remain in
most cases unchanged over time
ā¢ In evolutive cases the evolution is quite slow
ā¢ OCT and MP1 fundamental exams for diagnosing
and follow-up
25. 25
Observations
ā¢ Microperimetry provides important data for a
timely surgical decision
ā¢ Foveal sensitivity decrease and worsening of
fixation stability are significantly associated to
the need for surgery.
26. 26
Observations
ā¢ The decrease of sensitivity explored by MP1 is
a sign that may precede the objective
worsening of visual acuity
VA 20/25 VA 20/25
27. 27
ā¢Surgical removal of ER tissue represents the first
attempt to resolve the pathology
Observations
28. 28
ā¢ The reduction of posterior staphyloma by means of
posterior buckle is a method to use to repair the
unsuccessfull cases
Observations
29. 29
Observations
Vitreoretinal interface alterations in
highly myopic eyes have not been
univocally classified yet and the
concept itself of disease progression
and surgical indication are largely
debatable and deserve
standardization.
30. 30
Observations
Foveal sensitivity and fixation patterns
are associated to a variable risk of
progression and visual prognosis differs
significantly among groups. We believe
this variability represents underlying
separate pathologies that warrant
diversified treatment.