CaseWise 6

Staphyloma in Pathological Myopia -A case report

Dr. Sheetal Bajoria, Dr. Sarang Lambat, Dr. Vinay Nangia
Suraj Eye Institute, Nagpur

Introduction:
Posterior staphyloma, the posterior outpouching of the wall of the eye, is an important component of the diagnosis of pathologic myopia. The presence of staphyloma is specific to pathologic myopia and critically important in differentiating simple school myopia with good visual acuity and pathologic myopia that  may be associated with decrease in visual acuity. Spaide defines posterior staphyloma as “an outpouching of the wall of the eye that has a radius of curvature that is less than the surrounding curvature of the wall of the eye.” 1 Different types of staphylomas have been described by Curtin et al.3 Wang et al recently reported presence of staphylomas in eyes whose axial lengths measured less than 26.5 mm.2

Case Report:
A male, 37 years of age, came with chief complaints of sudden onset of floaters in right eye since 1 day. On examination his best corrected visual acuity (BCVA)  was 6/36 in RE with -11.75DS/+2.50DC@23 degrees and 6/36 in  LE with -15.50 DS/+3.50 DC@165 degrees and N6 in both eyes. His anterior segment examination was normal with IOP 18mmHg in both eyes. Fundus examination showed both eyes posterior staphyloma involving the optic disc. There was lattice degeneration seen in right eye from 11-1 o’clock and 8-10 o’clock .
He was advised Optical coherence tomography (OCT) and fundus photograph of both eyes which confirmed parapapillary staphyloma in both eyes and Fuch’s spot in right eye. Various features can be seen on Infrared photograph, colour photograph and SDOCT in such eyes of pathological myopia with staphyloma

Fig.1a shows RE OCT with horizontal line scan passing through disc with infrared image on right showing well defined margins of staphyloma(blue arrows). On the left OCT shows choroidal thinning(yellow arrow).
Fig.1b RE coloured fundus photograph showing staphyloma around the optic disc (blue arrows).
Fig.1c RE OCT with horizontal line scan passing through fovea shows Fuch spot(Yellow arrow).
Fig.2a shows LE OCT with horizontal line scan passing through disc with infrared image on right showing well defined margins of staphyloma(blue arrows). On the left OCT shows choroidal thinning(yellow arrow).
Fig.2b shows LE coloured fundus photograph showing staphyloma around the optic disc (blue arrows).
Fig.2c LE OCT with horizontal line scan passing through fovea shows choroidal thinning (Yellow arrow).
Fig.3 shows Curtin’s classification of types of posterior staphyloma

Discussion:
The posterior staphylomas were classified into different types and different grades. The type of posterior staphyloma was determined by the location, size, and severity (Figure 3) and was classified by binocular stereoscopic ophthalmoscopy by Curtin et.al. The staphylomas were classified into 10 types: types I through V were primary staphylomas, and types VI through X were compound staphylomas.3 Infrared images are important for documentation and understanding of extent of staphyloma. It helps in delineating the margins of staphyloma.
Fundus coloured photograph and OCT helps in understanding associated myopic degenerative changes like Fuch spot with staphyloma. However wide field OCT may help to determine the extent of large staphylomas. Staphylomas are found largely in association with increased axial length and therefore are also associated with significant myopic macular degenerative changes. Presence of myopic macular degenerative changes significantly affect the visual outcome.

References
1. Kyoko Ohno-Matsui et.al. Posterior Staphyloma in Pathological myopia Progress in Retinal and Eye Research Volume 70, May 2019 DOI:10.1016/j.preteyeres.2018.12.001

2.Wang NK, Yu YM, Wang JP, et al. Clinical characteristics of posterior staphylomas in myopic eyes with axial length . shorter than 26.5 mm. Am J Ophthalmol DOI:10.1016/j.ajo.2015.11.016

3. Hsiang HW, Ohno-Matsui K, Shimada N, Hayashi K, Moriyama M, Yoshida T, Tokoro T, Mochizuki M. Clinical characteristics of posterior staphyloma in eyes with pathologic myopia. Am J Ophthalmol. 2008 Jul;146(1):102-110. doi: 10.1016/j.ajo.2008.03.010. Epub 2008 May 2. PubMed PMID: 18455142. . doi:10.1016/j.ajo.2008.03.010

× Hello!