Longitudinal Progression Of Myopic Maculopathy In A Long-Term Follow-Up Of A European Cohort: Imaging Features And Visual Outcomes.

Abstract

Purpose: To evaluate the longitudinal progression of myopic maculopathy in a European cohort of highly myopic patients, analyzing disease natural history and its impact on visual function.

Design: Retrospective, observational monocentric cohort study.

Participants: The study included 1228 eyes from 781 highly myopic patients with a minimum follow-up time of 5 years. We collected best-corrected visual acuity (BCVA) measurement, axial length (AXL), fundus photography, and spectral-domain optical coherence tomography (SD-OCT), along with data regarding IOP-lowering drugs and glaucoma surgery.

Methods: Myopic atrophic maculopathy (MAM) was graded according to the ATN classification system. The presence of myopic staphyloma followed Curtin's classification. The development of myopic macular neovascularization (MNM) and myopic tractional maculopathy (MTM) was also assessed, along with the presence of dome-shaped macula (DSM) and lacquer cracks (LCs) at baseline.

Main outcome measures: Rate of MAM progression and visual outcomes. Secondary outcome included the correlation with the presence of staphyloma subtypes and the development of MNM and MTM.

Results: Mean AXL was 31.6±2.8 mm. MAM progressed in 57% of eyes over a mean follow-up of 11.4 years. Eyes with patchy atrophy progressed in 81% of cases, and 47% of them developed macular atrophy, while eyes with tessellated fundus progressed in only 19% of cases. The presence of a macular-involving staphyloma was associated with progression, particular for type IX (86% rate of progression). A significant decline in BCVA (≥2 lines) was observed in 35.8% of eyes, and correlated with AXL, glaucoma surgery, patchy atrophy, MNM and MTM development (all p<0.05). Active MNM developed in 190 eyes (15%), significantly associated with baseline LCs (OR 2.56) and DSM (OR 4.95), determined faster progression toward macular atrophy (OR 5.91). MTM complications were observed in 314 eyes (26%) and significantly correlated with the presence of a type I and II staphyloma.

Conclusions: More than half of eyes with myopic maculopathy tended to progress, in particular in cases with patchy atrophy at baseline and in eyes developing MNM or MTM, which caused worse vision loss during the study period. While DSM and LCs correlated with neovascular complications, the shape of posterior staphyloma correlated with tractional complications.