Polarization-Sensitive Optical Coherence Tomography Imaging of Posterior Staphyloma Edges in Eyes with High Myopia

PurposeTo investigate the arrangement and orientation of the collagen fibers in the inner and outer scleral layers at the edges of posterior staphylomas using polarization-sensitive optical coherence tomography (PS-OCT). Methods195 eyes of 105 highly myopic patients who underwent PS-OCT examinations between August 2023 and May 2024 at Institute of Science Tokyo were studied. The PS-OCT images were analyzed to assess the orientation and birefringence of scleral collagen fibers at the staphyloma edges, covering macular and inferior staphylomas. ResultsEighty-eight eyes of 60 highly myopic patients whose posterior staphylomas were confirmed in the ultra-widefield optical coherence tomography images underwent PS-OCT image processing. Thirty-six eyes from 27 patients were selected for further analysis. The optic axis images showed that 25 (18 upper and 7 lower) of 30 (83.3%) macular staphyloma edges had an aggregation of the inner scleral fibers, characterized by an arc-like gathering of the horizontal fibers along the edge. All eight upper edges from 8 eyes with an inferior staphyloma had an aggregation of the inner scleral fibers with relatively linear horizontal fibers across the macula. The birefringence images of the upper and lower edges of the macular and inferior staphylomas had different patterns, including a mixture of low and high, and relatively high birefringence. ConclusionsAn uneven aggregation of inner scleral fibers at the staphyloma edges in highly myopic eyes offers a more nuanced understanding of the pathogenesis of staphylomas. This finding also has pivotal implications for developing the targeted interventions to prevent the progression of staphylomas in eyes with high myopia.