The main fundus changes of pathologic myopia (PM) are posterior staphyloma (PS) and myopic maculopathy (MM), which includes myopic atrophy maculopathy (MAM), myopic tractional maculopathy (MTM), myopic neovascular maculopathy (MNM) and so on. The clinical manifestations of PM-related fundus lesions are complex, and the classification of PM has been a research hotspot in recent years. The proposal of each classification shows an increasing understanding of PM, and each classification has its advantages but also imperfections. For MM, it is recommended to refine the MTM classification based on the ATN classification and adjust it according to the internal correlation between MAM and MNM. The rapid development of modern imaging technology will promote the continuous update of the classification, and its further improvement will also help to understand the development process of PM, which has important clinical value in preventing its occurrence and progression.
Objective To observe the morphological characteristics of high myopia (HM) paravalvular abnormalities (PVA), and the correlation between different manifestations of PVA and myopic traction maculopathy (MTM) was analyzed. MethodsA cross-sectional clinical study. A total of 42 middle-aged and elderly patients with HM and PVA diagnosed by ophthalmology examination in Department of Ophthalmology, The Second Hospital of Hebei Medical University from June to December 2021 were included in the study. There were 24 eyes in 16 males and 48 eyes in 26 females. Age was (56.71±8.10) years old. Diopter was (－13.05±3.10) D. Axial length (AL) was (28.22±1.04) mm. According to the characteristics of ultra-wide-angle optical coherence tomography images, PVA morphology was divided into paravascular microfolds (PM), paravascular cysts (PC) and paravascular lamellar holes (PLH). MTM was divided into T0-T5 grades, of which MTM≥T3 was defined as severe MTM. The state of vitreoretinal junction was observed and the state of posterior vitreous detachment (PVD) was recorded, which divided into complete PVD and partial PVD. Partial PVD was divided into macular fovea adhesions and paravascular adhesions according to the vitreoretinal adhesions. Posterior scleral staphyloma (PS) was divided into 6 types by ultra-wide-angle fundus photography. Logistic regression model was used to analyze the factors related to MTM. ResultsIn 72 eyes, PM, PC and PLH were 72 (100.0%, 72/72), 62 (86.1%, 62/72) and 29 (40.3%, 29/72) eyes, respectively. Among them, there were 10 (13.9%, 10/72) eyes with PM alone, 33 (45.8%, 33/72) eyes with PM and PC, and 29 (40.3%, 29/72) eyes with PM, PC and PLH, respectively. There were 42 eyes with partial PVD (58.3%, 42/72), among which the macular fovea and paravascular adhesion were 22 (52.4%, 22/42) and 24 (57.1%, 24/42) eyes, respectively. PS was present in 50 eyes (69.4%, 50/72), among which 27 (54.0%, 27/50), 21 (42.0%, 21/50), 1 (2.0%, 1/50), and 1 (2.0%, 1/50) eyes were types Ⅰ to Ⅳ, respectively. Multivariate logistic regression analysis showed that AL[odds ratio (OR)=16.139, 95% confidence interval (CI) 4.062-64.120, P＜0.001], PS (OR=4.212, 95%CI 1.234-14.378, P=0.022), paravascular vitreoretinal adhesion (OR=3.478, 95%CI 11.124, P=0.036) were risk factors for PM, PC and PLH. MTM was present in 58 eyes (80.6%, 58/72), among which T1 was the most common type in 19 eyes (26.4%, 19/72). Univariate logistic regression analysis showed that the occurrence of MTM was significantly correlated to PS (OR=4.190, 95%CI 1.240-14.157, P=0.021), coexistence of PM, PC and PLH (OR=11.323, 95%CI 1.389-92.311, P=0.023), and PS were significantly correlated. There was no correlation with PVD (OR=1.889, 95%CI 0.580-6.150, P=0.291) or PS (OR=2.778, 1.786; 95%CI 0.700-11.023; 0.445-7.167; P=0.146, 0.413). There was significant difference in the incidence of severe MTM between PM alone, PM combined with PC and coexistence of PM, PC and PLH (χ2=20.943, P＜0.001). ConclusionsPM is the most common and earliest manifestation of PVA in middle-aged and elderly HM patients. AL, PS and paravascular vitreoretinal adhesion are risk factors for PM, PC and PLH. The coexistence of three PVA forms may be a marker of severe MTM.