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.

1. 1
The author has no potential
conflict of interest to disclose

2. 2
Modificazioni Vitreo-Retiniche negli
Stafilomi nel Miope Elevato ed Eventuali
Indicazioni Chirurgiche.
Guido Ripandelli
Tommaso Rossi*
Fabio Scarinci
Mario Stirpe
IRCCS – Fondazione Bietti, Roma
*Ospedale Oftalmico, Roma

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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
• 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?
• Study design: retrospective, single
Institution series

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Patients’ characteristics
• December 1999 - December 2004
• 408 phakic eyes / 204 subjects
• 108 Males / 96 Females
• Age 22-58 years
• Myopia 18-30 D and PS (Axial lenght 30-34
mm)

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Inclusion Criteria
• AL > 30 mm
• Presence of posterior staphyloma
• Availability of OCT, MP1 at baseline, at
latest examination, (before and after
surgery)

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Exclusion Criteria
Patients with incomplete charts, lost at follow-
up, with significant media opacities, with
previous ocular surgery

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Characteristics of patients
with VR changes
• Prevalence of posterior VR changes: 236/408 (57.8%) eyes
• Minimum follow-up: 5 years
• Lost to follow-up: 22/236 eyes (9.3%)
• Included in the study: 214 eyes (116 subjects)
– Bilateral VR changes 98/116 (84.4%)
– 54 males /62 females
– Age 24-59 years
– Myopia 19-30 D (29.5-34 mm)
– 209 eyes: visual acuity 20/50-20/20
– 5 eyes: C F – 20/100

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Testing
• Visual acuity (VA)
• Biomicroscopy
• Optical Coherence Tomography (OCT)
• MP1 Microperimetry
• A, B-scan ultrasound

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Group 1 Epiretinal membrane without retinal changes (EM) : 98 eyes
Group 2 Macular schisis with/without epiretinal membrane (MSEM): 54 eyes
Asymptomatic macular schisis with EM (AMSEM, 33 eyes)
Symptomatic macular schisis with EM (SMSEM, 14 eyes)
Posterior stretch schisis (PSS, 7 eyes)
Group 3 Partial thickness macular hole (PTMH): 24 eyes
PTHM with retinal schisis (15 eyes)
PTHM without retinal schisis (9 eyes)
Group 4 Full thickness macular hole (FTMH): 18 eyes
Asymptomatic full thickness macular hole (AFTMH, 9 eyes)
Symptomatic full thickness macular hole (SFTMH, 9 eyes)
Group 5 Posterior retinal detachment (PRD): 20 eyes
PRD with macula on (PRD M-on, 11 eyes)
PRD with macula off (PRD M-off, 4 eyes)
PRD with macular hole (PRDMH, 5 eyes)

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Gr. 1 Epiretinal membrane without
retinal changes (EM)
98 eyes (45.7%)

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Gr. 2 Macular schisis with/without epiretinal membrane
(MSEM, 54 eyes)
Asymptomatic macular schisis with epiretinal membrane (AMSEM)
33 eyes (15.4%)

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Symptomatic macular schisis with epiretinal membrane (SMSEM)
14 eyes (6.5%)
Gr. 2 Macular schisis with/without epiretinal membrane
(MSEM, 54 eyes)

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Posterior stretch schisis (PSS)
7 eyes (3.3%)
Gr. 2 Macular schisis with/without epiretinal membrane
(MSEM, 54 eyes)

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Gr. 3 Partial thickness macular hole ( PTMH, 24 eyes)
PTMH with macular schisis
15 eyes (7%)

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Gr. 3 Partial thickness macular hole ( PTMH, 24 eyes)
PTMH without macular schisis
9 eyes (4.2%)

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Asymptomatic full thickness macular hole (AFTMH)
9 eyes (4.2%)
Gr. 4 Full thickness macular hole ( FTMH, 18 eyes)

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Symptomatic full thickness macular hole (SFTMH)
9 eyes (4.2%)
Gr. 4 Full thickness macular hole ( FTMH, 18 eyes)

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PRD in the staphyloma area with macula on (PRD M-on)
11 eyes (5.1%)
Gr. 5 Posterior retinal detachment (PRD, 20 eyes)

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PRD in the staphyloma area with macula off (PRD M-off)
4 eyes (1.8%)
Gr. 5 Posterior retinal detachment (PRD, 20 eyes)

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PRD with macular hole (PRDMH)
5 eyes (2.3%)
Gr. 5 Posterior retinal detachment (PRD, 20 eyes)

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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

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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.

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Observations
• High myopic eyes with posterior staphyloma
show high frequency of vitreoretinal alterations
(57.8%)
• Bilateral vitreoretinal changes on 84.5% patients
• Anatomical changes and visual acuity remain in
most cases unchanged over time
• In evolutive cases the evolution is quite slow
• OCT and MP1 fundamental exams for diagnosing
and follow-up

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Observations
• Microperimetry provides important data for a
timely surgical decision
• Foveal sensitivity decrease and worsening of
fixation stability are significantly associated to
the need for surgery.

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Observations
• 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

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•Surgical removal of ER tissue represents the first
attempt to resolve the pathology
Observations

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• The reduction of posterior staphyloma by means of
posterior buckle is a method to use to repair the
unsuccessfull cases
Observations

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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.

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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.