IMPACTS OF POSTERIOR STAPHYLOMA ON PARAPAPILLARY MICROVASCULATURE AND ATROPHY IN HIGH MYOPIC EYES: A Matched Cohort Study With Optical Coherence Tomography Angiography.

Purpose: To evaluate the impacts of the different types of posterior staphyloma (PS) in high myopia on parapapillary microvasculature and parapapillary atrophy (PPA, i.e., γ-zone and δ-zone) with optical coherence tomography angiography.

Methods: This cross-sectional study included 152 high myopic eyes (152 participants) with γ-zone. After matching, high myopic eyes were stratified into PS (n = 33) and non-PS (n = 33) groups. Posterior staphyloma types, parapapillary microvasculature characteristics, the prevalence of nonjuxtapapillary microvasculature dropout, the longest radial width from the optic disk edge to retinal pigment epithelial atrophy edge (PPA width), γ-zone, and δ-zone with changes in visual field, and best-corrected visual acuity were evaluated and analyzed.

Results: According to Curtin classification, we identified five types of PS included: primary Types I, II, III, and compound Types VII, and IX. Eyes with Type II showed a higher optic disk tilted ratio and larger PPA width compared with other primary PS. Subjects with Type IX were the oldest. Eyes with Types VII and IX had wider γ-zone and δ-zone, worse visual field outcomes, poorer best-corrected visual acuity, and a higher incidence of non-juxtapapillary microvasculature dropout compared with primary PS. Choroidal and intrascleral vessels were associated with nonjuxtapapillary microvasculature dropout and were located near or connected to the circle of Zinn-Haller.

Conclusion: Eyes with high myopia and PS show wider PPA, affecting the γ-zone and δ-zone, and are at a higher risk of developing nonjuxtapapillary microvasculature dropout. Specifically, eyes with PS Types VII and IX are more susceptible to visual field damage and decreased best-corrected visual acuity. These results highlight the importance of the impact of PS on parapapillary microvasculature and PPA in high myopia.