Flores-Moreno Ignacio, Puertas Mariluz, Fernández-Jiménez Marina, Franco Luis Celestino, Terrón-Vilalta María, Eslava Blanca, Almazán-Alonso Elena, Ruiz-Medrano Jorge, Kudsieh Bachar, García-Zamora María, Ruiz-Moreno José M
From the Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain (I.F.-M., M.P., M.F.-J., L.C.F., M.T.-V., B.E., E.A.-A., J.R.-M., B.K., M.G.-Z., J.M.R.-M.); Clínica Suárez Leoz, Madrid, Spain (I.F.-M.).
From the Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain (I.F.-M., M.P., M.F.-J., L.C.F., M.T.-V., B.E., E.A.-A., J.R.-M., B.K., M.G.-Z., J.M.R.-M.).
Am J Ophthalmol. 2025 Feb;270:164-171. doi: 10.1016/j.ajo.2024.09.035. Epub 2024 Oct 9.
To analyze myopic maculopathy's progression pattern.
Retrospective, observational case series.
A total of 824 highly myopic eyes (axial length ≥26 mm) of 430 patients examined at Puerta de Hierro-Majadahonda University Hospital (Madrid, Spain) with a minimum follow-up of 2 years. All patients underwent complete ophthalmologic examination, including multimodal imaging. Progression of myopic maculopathy was assessed according to ATN classification system at baseline and throughout the follow-up, as well as associated clinical features.
Progression of myopic maculopathy was described in 42% of eyes over a mean follow-up of 4.10 ± 1.28 (range, 2.00-6.23) years. Compared with nonprogressing eyes, myopic maculopathy progression correlated with worse best-corrected visual acuity (BCVA) at follow-up (P < .05) and greater BCVA loss (P < .01). There were no significant differences between groups in axial length, gender, and age (P > .05). Eyes with posterior staphyloma (PS) and, particularly, those with macular PS showed significantly greater myopic maculopathy progression (P < .01). The likelihood of myopic maculopathy's progression was 3.94 times higher (odds ratio, 3.94 ± 1.22, P < .01) in eyes with PS compared with those without PS. Atrophic progression occurred in 21.9% of eyes, with diffuse to patchy atrophy being the most common pattern (54.17%). Tractional progression was observed in 22.8% of eyes, predominantly from nontraction to inner/outer foveoschisis (40%). Neovascular progression affected 11.4% of the eyes, most of them from no neovascular component to macular lacquer cracks (40%).
This study highlights significant myopic maculopathy progression over the natural course of the disease, compromising the BCVA as macular complications progress. Myopic maculopathy progression was significantly associated with PS, especially in those with macular involvement.
分析近视性黄斑病变的进展模式。
回顾性观察病例系列。
对西班牙马德里Puerta de Hierro-Majadahonda大学医院检查的430例患者的824只高度近视眼（眼轴长度≥26mm）进行研究，随访至少2年。所有患者均接受了包括多模态成像在内的完整眼科检查。根据ATN分类系统在基线和整个随访过程中评估近视性黄斑病变的进展情况以及相关临床特征。
在平均4.10±1.28（范围2.00 - 6.23）年的随访中，42%的眼睛出现近视性黄斑病变进展。与未进展的眼睛相比，近视性黄斑病变进展与随访时较差的最佳矫正视力（BCVA）相关（P <.05）以及更大的BCVA损失相关（P <.01）。两组在眼轴长度、性别和年龄方面无显著差异（P >.05）。有后巩膜葡萄肿（PS）的眼睛，特别是黄斑部有PS的眼睛，显示出明显更高的近视性黄斑病变进展（P <.01）。与没有PS的眼睛相比，有PS的眼睛发生近视性黄斑病变进展的可能性高3.94倍（优势比，3.94±1.22，P <.01）。21.9%的眼睛发生萎缩性进展，弥漫性至斑片状萎缩是最常见的模式（54.17%）。22.8%的眼睛观察到牵引性进展，主要是从无牵引到内/外黄斑劈裂（40%）。新生血管性进展影响11.4%的眼睛，其中大多数是从无新生血管成分到黄斑漆裂纹（40%）。
本研究强调在疾病自然进程中近视性黄斑病变有显著进展，随着黄斑并发症的进展会损害BCVA。近视性黄斑病变进展与PS显著相关，尤其是黄斑受累的患者。
