ROLE OF INFLAMMATION IN ATROPHY DEVELOPMENT AND PROGRESSION IN PATHOLOGIC MYOPIA

To describe the progression of atrophy in pathologic myopia eyes with prior retinal inflammatory lesions consistent with punctate inner choroidopathy.

Retrospective case series of 21 eyes with pathologic myopia and resolved retinal inflammatory lesions compared with 26 noninflamed controls (14 fellow eyes; 12 external myopic eyes with pre-existing patchy atrophy). The primary outcome was annual atrophy-area change (mm2/year) on multimodal imaging. Secondary outcomes included incident/enlarging atrophy, multifocal versus unifocal appearance, and META-PM category progression. Group comparisons used Welch t tests and Fisher exact tests; an age-adjusted linear regression examined independent associations.

Over 5.2 ± 3.2 years in inflamed eyes and 5.3 ± 2.4 years in controls, patchy atrophy progressed faster with inflammation (0.76 ± 0.67 vs. 0.38 ± 0.47 mm2/year; P = 0.03). Among eyes starting in myopic macular degeneration Category 1 to 2, incident atrophy occurred in 14 of 14 (100%) inflamed versus 4 of 11 (36.4%) controls (P < 0.01). Overall atrophy activity (new or enlarging) was 21 of 21 (100%) in inflamed eyes versus 19 of 26 (73.1%) controls (P < 0.01). Multifocal atrophy was more frequent with inflammation (15/21, 71.4%) than in controls (6/26, 23.1%; P < 0.01). In age-adjusted regression, inflammation remained independently associated with faster atrophy expansion (β = 0.41 mm2/year; 95% CI, 0.04-0.78; P = 0.033).

In pathologic myopia, prior retinal inflammation is independently associated with more frequent multifocal involvement, higher risk of incident atrophy, and a substantially faster atrophy-expansion. Beyond mechanical factors, inflammation seems to be a key driver of atrophic progression in this population.