Classification of posterior staphyloma in pathologic myopia using 3D wide-field fundus imaging

Introduction and objectives

Pathological myopia is associated with structural changes, including posterior staphylomas, which can be categorized based on their morphology. This study aims to classify posterior staphylomas in patients with pathological myopia using the 3D WIDE SCAN REVIEW Swept-Source optical coherence tomography (OCT) platform and compare the findings with the Ohno-Matsui classification.

Patients and methods

We conducted a retrospective cross-sectional cohort study, including 59 eyes from 31 patients diagnosed with high myopia (axial length ≥ 26 mm and/or spherical equivalent ≥ −6.00 diopters) and pathological myopia, defined as equal to or greater than diffuse chorioretinal atrophy or the presence of a posterior staphyloma, according to the META-PM study group. Posterior staphylomas were categorized based on fundus depression shape and appearance using 3D WIDE SCAN REVIEW analysis and compared using the Ohno-Matsui 2014 classification. Additionally, myopic maculopathy was assessed using the Atrophic-Tractional-Neovascular (ATN) classification, explicitly evaluating atrophic (A), tractional (T), and neovascular (N) components. Image acquisition was performed using the Topcon Triton Swept-Source OCT system, and images were processed and analyzed with the 3D WIDE SCAN REVIEW platform.

Results

The patients’ mean age was 49.56 years (SD ± 18.50; 71.05% women). The distribution of posterior staphylomas varied among the study population. Type I (wide macular) was the most prevalent, observed in 22.0% of cases, followed by Type II (narrow macular) at 10.2%, Type III (peripapillary) at 8.5%, Type IV (nasal) at 3.4%, and Type V (inferior) at 8.5%. This classification highlights the predominance of macular involvement in pathological myopia, with nasal and inferior staphylomas being less common. Regarding myopic maculopathy, A1 was the most common atrophic component (43.5%), T0 was predominant (78.3%), and N0 was the most common neovascular category (83%).

Conclusions

The 3D WIDE SCAN REVIEW Swept-Source OCT platform provides a high-resolution, non-invasive method for detailed visualization and classification of posterior staphylomas. By using Topcon Triton SS-OCT for image acquisition and 3D WIDE SCAN REVIEW software for analysis this study demonstrates a clinically viable alternative to traditional imaging modalities for evaluating posterior staphylomas in pathological myopia.