Elsevier

Ophthalmology

Volume 114, Issue 9, September 2007, Pages 1755-1762.e1
Ophthalmology

Original Article
Morphology and Long-term Changes of Choroidal Vascular Structure in Highly Myopic Eyes with and without Posterior Staphyloma

https://doi.org/10.1016/j.ophtha.2006.11.034Get rights and content

Purpose

To determine whether the choroidal vasculature is altered in highly myopic eyes with or without posterior staphyloma using indocyanine green angiography. In addition, to analyze long-term changes of the choroidal vasculature in patients who were observed for at least 5 years with indocyanine green angiography.

Design

Consecutive, retrospective, observational case series.

Participants

Three hundred twenty-one eyes of 195 patients with high myopia.

Methods

Indocyanine green angiograms were analyzed, and the effect of posterior staphyloma on the choroidal vasculature was studied. Changes in the indocyanine green–determined choroidal vasculature detected after at least 5 years were analyzed in 57 eyes of 36 patients.

Main Outcome Measures

Indocyanine green angiography assessment of the choroidal vasculature.

Results

A choroidal flush was detected in all of the control eyes but only 52 (16.2%) of the 321 highly myopic eyes. A displacement of the entry site of the posterior ciliary arteries into the choroid was observed in 76.6% of the eyes with posterior staphyloma and in 25.3% of the eyes without (P<0.001). There were fewer large choroidal veins in the posterior fundus, and in some cases, there was marked variation in the diameter of neighboring large choroidal veins in the highly myopic patients. Of 57 eyes that were followed for >5 years, 9 (15.8%) showed changes in the choroidal vascular structure in the later indocyanine green angiograms. Four of 9 eyes showed dilation or enlargement of posterior routes of choroidal venous outflow, 5 showed narrowing of the large choroidal veins, and 2 had a loss of the large choroidal veins (overlapped). One patient developed choroidal neovascularization after loss of the large choroidal veins.

Conclusions

These findings indicate that the choroidal vasculature can be significantly altered in highly myopic eyes, and this is more prevalent in eyes with posterior staphyloma. Whether these alterations are related to the development of chorioretinal lesions in highly myopic eyes is now being investigated.

Section snippets

Patients and Methods

The medical records of 420 eyes of 212 patients with high myopia (≥6 D, or axial length ≥ 26.5 mm) who were examined in our high myopia clinic at the Tokyo Medical and Dental University and had had indocyanine green angiography were retrospectively analyzed. Indocyanine green angiography was routinely performed at their initial examination in our high myopia clinic. Of these, 321 eyes of 195 myopic patients were included in the study. Excluded were 75 patients (93 eyes) with expanding areas of

Results

Of the 195 patients, 64 were men and 131 were women, and their mean (± standard deviation) age was 47.2±15.6 years (range, 7–81). Six eyes were pseudophakic, and the refractive error in the remainder ranged from −5.0 to −32.0 D, with a mean of −14.1±4.8 D. Mean axial length was 29.2±1.8 mm (range, 25.2–33.6). The 321 eyes were divided into 2 groups: 210 eyes with posterior staphyloma and 111 eyes without posterior staphyloma. Mean intraocular pressure (IOP) in the highly myopic group did not

Discussion

These results demonstrate that the choroidal vascular pattern in highly myopic eyes shows some specific features. The normal choroidal flush was absent in a high percentage of eyes, and the entry site of posterior ciliary arteries into the choroid was displaced toward the periphery. There were fewer large choroidal veins in the posterior fundus, and the remaining choroidal veins showed marked variations in their diameter. These findings were significantly more common in eyes with posterior

Acknowledgment

The authors thank Prof Duco Hamasaki for his critical discussion and final manuscript revision.

References (16)

There are more references available in the full text version of this article.

Cited by (93)

  • Myopia: Histology, clinical features, and potential implications for the etiology of axial elongation

    2023, Progress in Retinal and Eye Research
    Citation Excerpt :

    In eyes with a macular BM defect with choroidal vessels, the inter-vessel distance in the choroidal large vessel layer did not change notably (Jonas, JB et al., 2021a). The finding of a decrease in the large choroidal vessel density (i.e., an increase in the choroidal inter-vessel distance) confirms a previous report by Moryama and colleagues, who also observed a decrease in the number of large vessels in the choroid (Moriyama et al., 2007). The changes in the position of the large choroidal vessels occurring in association with an enlargement of a parapapillary gamma zone may be explained by a shift of BMO into the temporal direction in axially elongating eyes (Figs. 10–12).

View all citing articles on Scopus

Manuscript no. 2006-792.

Supported in part by the Japan Society for the Promotion of Science, Tokyo, Japan (research grant nos. 16390495, 17591823).

The authors do not have financial interest in any products/drugs discussed in the article.

View full text