Indian Journal of Ophthalmology

PHOTO ESSAY
Year
: 2019  |  Volume : 67  |  Issue : 7  |  Page : 1173--1174

Multimodal imaging to differentiate myopic macular pit and localized deep staphyloma in high myopia


Jaya Prakash Vadivelu, Amravi Shah, Vikas Khetan, Gopal Lingam 
 Sri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, India

Correspondence Address:
Dr. Jaya Prakash Vadivelu
Sri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai - 600 006, Tamil Nadu
India




How to cite this article:
Vadivelu JP, Shah A, Khetan V, Lingam G. Multimodal imaging to differentiate myopic macular pit and localized deep staphyloma in high myopia.Indian J Ophthalmol 2019;67:1173-1174


How to cite this URL:
Vadivelu JP, Shah A, Khetan V, Lingam G. Multimodal imaging to differentiate myopic macular pit and localized deep staphyloma in high myopia. Indian J Ophthalmol [serial online] 2019 [cited 2024 Mar 29 ];67:1173-1174
Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?2019/67/7/1173/260997


Full Text



High myopia is linked to pathological changes, such as posterior staphyloma, optic disc changes and myopic macular degeneration (MMD) including chorioretinal atrophy (CRA), lacquer cracks, choroidal neovascular membrane (CNVM), and Foster-Fuchs spots.[1],[2]

The swept-source optical coherence tomography (SS-OCT) uses longer wavelength which penetrates deeper than conventional OCT.[3] With advent of such enhanced depth imaging and improved resolution of deeper structures, various lesions in the thinned out choroid and sclera of highly myopic eyes, namely peripapillary pits, macular intrachoroidal cavitation and myopic macular pits (MMP) have been described.[4] The extrascleral soft tissues can also be imaged in areas of severe CRA.

The MMPs are focal areas of absence of retinal and choroidal tissue at macula with alteration in the scleral curve in highly myopic fundus. Multimodal imaging helps in evaluation of MMPs and we present two similar appearing cases, one an MMP and another a localized deep staphyloma.

 Case Reports



Case 1

A 57-year-old high myopic lady with MMD and scarred CNVM had best corrected vision (BCVA) of 2/60 in both her eyes. In the left eye, there was a yellowish-brown oval depressed lesion, measuring 0.58 × 0.53 mm, inferior to fovea, within an area of patchy CRA. A retinal vessel dipped in, branched and continued along the superotemporal margin. MMP was suspected and confirmed on multimodal imaging [Figure 1].{Figure 1}

Case 2

A 69-year-old high myopic gentleman had BCVA of 3/60, N12 in right eye and 2/60, N24 in left eye. Axial length was 31 mm bilaterally. Fundus was similar to case-1 but right eye had macular hole with schisis and a round well-defined dark-brown excavated area, inferior to fovea, measuring 1.21 × 1.15 mm, with pigmentation in superior part. [Figure 2] Inner retinal layers were intact over this excavation. The indocyanine green angiography (ICGA) revealed cilioretinal artery arising more nasally, branching, dipping and reemerging along the margins. Hence, this was just a localized deep posterior staphyloma and not an MMP as in the first case.{Figure 2}

 Discussion



Not much is known about the pathogenesis of MMPs.[4],[5] In a previous reported case,[4] scleral dehiscence was suspected but could not be demonstrated on OCT due to shadowing from pigmentation. ICGA showed that MMPs existed at sites of emissary canals of short posterior ciliary arteries.[4] The continuous mechanical tension onto macular CRA may also lead to MMPs and this may explain why MMPs occur only within areas of CRA.[4]

They are at risk of perforation during retrobulbar block and maybe sensitive to intraocular pressure fluctuations during intravitreal injections and surgery.

Further studies using multimodal imaging would shed light on pathogenesis of MMPs. MMPs are rare and this photo essay illustrates the utility of multimodal imaging in evaluation of MMPs and differentiating from localized posterior staphylomas.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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3Yun SH, Bouma BE. Wavelength swept lasers. In: Drexler W, Fujimoto JG, editors. Optical Coherence Tomography: Technology and Applications. New York, NY: Springer; 2008. p. 359-78.
4Ohno-Matsui K, Akiba M, Moriyama M. Macular pits and scleral dehiscence in highly myopic eyes with macular chorioretinal atrophy. Retin Cases Brief Rep 2013;7:334-7.
5Freitas-da-Costa P, Falcão M, Carneiro A. Infrared reflectance pattern of macular pits in pathologic myopia. JAMA Ophthalmol 2015;133:e1580.