Aiming to fill a gap left by previous research, a small study took a long-term look at the presence of serous retinal detachment (SRD) in different types of posterior staphyloma, including treatment effect and visual outcome. BCVA at the final visit was not significantly different from BCVA at baseline and showed no significant change in treated vs. untreated eyes. Additionally, resolution of SRD occurred in 31% of the eyes without treatment.
|Treatment modalities in patients with staphyloma-induced serous maculopathy showed no significant change in BCVA vs. untreated eyes, suggesting a wait-and-see approach may be preferred. Photo: Ravenstijn M, Martinez-Ciriano JP, de Graaf GW, et al. Ophthalmol Retina 2023/Creative Commons. Click image to enlarge.
Twenty-six eyes of 20 patients were followed for a minimum of 20 months, some of which were left untreated and others received one or more varying treatments, including photodynamic therapy (PDT), anti-VEGF and topical prednisolone. During follow-up, the SRD disappeared in 50% of eyes, and then reappeared in 35%. Of the 20 eyes that received treatment, SRD resolved in 21% of the PDT group, 40% of the anti-VEGF group, and 50% of those treated with topical prednisolone. Location of the staphyloma was also noted: 46% inferiorly, inferonasally in 27% and nasally in 27%.
Posterior staphyloma is associated with worse visual acuity and OCT imaging can reveal abrupt changes of the retina, choroidal thickness and sclera, making the staphyloma edge more susceptible to complications, including SRD. Previous studies have focused on eyes with tilted disc syndrome and inferior staphyloma due to their prevalence of macular SRDs, ranging from 17% to 41%. In this particular study population, all eyes showed changes in the choroidal vasculature, and although the subfoveal choroidal thickness was an expected 174±54μm (based on age and axial length), the authors noted an abrupt change of the choroidal thickness at the edge of the staphyloma in 65%, with a more gradual change in the remaining eyes. They explained that multimodal imaging that includes OCT, fluorescein angiography (FA) and indocyanine green angiography (ICGA) should be performed to identify such characteristics and avoid misdiagnosis.
The authors cited the strengths and limitations of their study, saying, “One of the strengths is that this case series describes the natural course of staphyloma-induced serous maculopathy (SISM) with the longest follow-up currently available. While other studies focused on tilted disc syndrome alone, we included all types of posterior staphylomas. This allowed us to compare the multimodal imaging of different types of staphylomas and to conclude that all staphyloma edges can be complicated with SRDs. Another strength is our long-term follow-up on treated eyes, allowing [us] to investigate the effect of the treatment on the change in SRD and BCVA. The limitations of this study lie in the retrospective design and the relatively small numbers, which limited our statistical power to compare different treatment groups. Nonetheless, this is one of the largest case-series on SISM with the longest follow-up.”
While patients experience suboptimal visual acuity that remains stable despite the SRD presence over time, the authors said it’s important to distinguish SISM from other complications that may benefit from treatment, such as myopic macular neovascularization and central serous chorioretinopathy. “Patients with SISM have a very typical FA and ICGA pattern, but OCT is less discriminating. Therefore, FA and ICGA at baseline are essential in all eyes with posterior staphyloma and subretinal fluid to exclude other diagnoses. The SRD fluctuated and resolved without treatment in 31% of the SRD episodes. Many treatments were tried in these patients, but none of these appeared overwhelmingly successful. Since SRD can resolve spontaneously and treatment does not change the visual prognosis, a wait-and-see policy is advocated in these patients,” they concluded.
Ravenstijn M, Martinez-Ciriano JP, de Graaf GW, et al. Staphyloma-induced serous maculopathy: natural course and treatment effects. Ophthalmol Retina 2023. ePub ahead of print.