Myopic Maculopathy Progression: Insights Into Posterior Staphyloma and Macular Involvement

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.