Perivascular Chorioretinal Atrophy: An Unusual Feature in Pathologic Myopia Eyes

To describe a largely unrecognized feature in pathologic myopia, namely, perivascular patchy chorioretinal atrophy (PVCA).

Cross-sectional study.

A total of 604 eyes of 312 highly myopic patients followed at Strasbourg University Hospitals were reviewed for the presence of PVCA lesions. Demographic, clinical, and paraclinical data (ultra-widefield retinography, optical coherence tomography [OCT], fluorescein and indocyanine green angiography images) were analyzed. Controls were matched for age, sex, and axial length (AL).

A total of 47 eyes (7.8%) of 32 patients presented with 88 PVCA lesions in total. Mean age was 65.9 ± 10.2 years, and mean best corrected visual acuity (BVCA) was 0.86 ± 0.76 logMAR. All patients had posterior staphyloma, with PVCA localized within the staphyloma (58%), on its margins (39%), or outside of it (3%). Atrophic lesions were mainly located in the temporal retina (71%) and on the first- or second-order branches of the central retinal vessels (95%). OCT scans revealed an anterior scleral protrusion in 74% of cases, with an average height of 319 ± 152 µm. PVCA patients had longer AL (32.94 ± 1.87 mm vs 29.96 ± 2.79 mm; P < .01) than non-PVCA patients. When compared to matched controls, PVCA patients had lower BCVA (0.86 ± 0.76 logMAR vs 0.59 ± 0.71 logMAR; P = .01) and reduced macular choroidal thickness (38 ± 31 µm vs 54 ± 38 µm; P = .02).

PVCA is a newly described feature of pathological myopia associated with reduced visual acuity. Its association with anterior scleral protrusion suggests that scleral curvature change may represent a specific cause leading to chorioretinal atrophy.