Macular changes among adult Egyptian patients with pathological myopia

To investigate macular changes characteristics among adults with high myopia in Egypt, and to evaluate the relationship between the degree of myopia and the extent of macular alterations.

A series of highly myopic eyes with axial length (AL)≥26.0 mm and/or spherical equivalent (SE)≤-6.0 D were included. All subjects underwent automated refraction, correction of refractive error, AL measurement, and optical coherence tomography (OCT) for macular scanning. Myopic maculopathy (MM) for each eye was recorded, and their association with age, refractive error, and AL was determined.

Among the 427 eyes (mean SE: -11.11±4.34 D, mean AL: 27.84±1.66 mm) of 250 subjects (77 males, mean age 56.84±12.19y), all had tigroid fundus (A1, ATN classification of MM), associated macular lesions were chorioretinal atrophy [C-R atrophy; 8.47% diffuse C-R atrophy (A2), 11.0% patchy C-R atrophy (A3)]. Neovascular MM was: lacquer cracks in (N1) 1.64%, myopic choroidal neovascularization [mCNV; 6.09% active CNV (N2a), 19.20% choroidal neovascular membrane (N2b)], myopic traction maculopathy (MTM) in 11.48%, macular hole (MH; 3.98% lamellar MH, 2.34% full thickness MH). Older age was associated with MTM, MH, and lacquer cracks (P=0.004, P=0.025, P=0.013). More myopic SE was associated with increased odds of atrophic MM, neovascular MM, and MTM (P<0.001, P<0.001, P=0.002). Increased AL was associated with increased odds of atrophic MM, neovascular MM, and dome shape macula (P=0.049, P=0.037, P=0.001). In the multivariable linear mixed model with adjustment of age, gender and SE: the presence of atrophic MM (P<0.001), neovascular MM (P<0.001) were significantly associated with poorer best corrected visual acuity (BCVA).

Among adult Egyptian patients with high myopia: age, more myopic SE and longer AL are associated with increased odds of MM. Atrophic or neovascular MM is associated with poorer visual acuity.