Myopic Degeneration



Myopic Degeneration





SALIENT FEATURES



  • Myopic degeneration may occur in eyes that typically have a refractive error exceeding -6.00D or axial length of at least 26.5 mm along with posterior pathology due to axial elongation.


  • The most common retinal pathology in myopic degeneration is the development of posterior staphyloma.


  • Posterior staphyloma may have two visually significant components: tractional and degenerative components.



    • Tractional component: the bulging staphyloma may result in differential stretching of the retinal layers. While the outer layers may be more elastic and expand with the staphyloma, the internal limiting membrane may become more taut resulting in stretching of the overall retina. This may progress to separation of the neurosensory and epiretinal layers (macular foveoschisis) or progress to a macular hole (see Chapter 35, Myopic Macular Schisis and Tractional Retinal Detachment).


    • Degenerative component: the bulging staphyloma results in choroidal thinning and choroidal neovascularization. This presents with lacquer cracks and retinal pigment epithelium (RPE) atrophy.


  • Macular foveoschisis is best observed with optical coherence tomography (OCT).


  • Fluorescein angiography (FA) in combination with OCT is the historic gold standard for detecting choroidal neovascularization in myopic degeneration.


  • Optical coherence tomography angiography (OCTA) may be used as an noninvasive alternative to FA for visualizing vessels.







FIGURE 26.1 Myopic degeneration with associated myopic foveoschisis. Taut internal limiting membrane (ILM) and epiretinal membrane (ERM) (yellow arrow) are noted nasally with underlying myopic schisis. Subretinal fluid is also present (arrowhead). Diffuse ellipsoid zone attenuation is present with underlying choroidal thinning (white arrow). Significant curvature of the posterior eye wall is noted, consistent with high myopia.


OCT IMAGING

May 10, 2021 | Posted by in OPHTHALMOLOGY | Comments Off on Myopic Degeneration
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