Retinal pigment epithelial changes and choroidal neovascularisation at the edge of posterior staphylomas; a case series and review of the literature

To report five myopic patients who presented with a variety of changes at the edge of posterior staphyloma. Retrospective, observational case series. The clinical and angiographic records of five patients who showed changes at the edge of posterior staphyloma were reviewed. One of these patients had been referred querying macular dystrophy. On fundus examination, three patients showed retinal pigment epithelial (RPE) changes at the edge of the staphyloma and two showed RPE atrophy with surrounding haemorrhages. Fluorescein angiography revealed areas of hyperfluorescence at the point of change of curvature of the staphyloma suggestive of RPE atrophy in all patients. In two patients, a choroidal neovascular membrane was seen. Indocyanine green angiogram carried out in one patient showed the presence of an occult choroidal neovascular membrane with preservation of the adjacent choriocapillaris. This case series illustrates the variety of changes that can occur at the edge of posterior staphylomas, which ranged from RPE disturbance to choroidal neovascular membrane formation. In one of the patients, these changes were mistaken for macular dystrophy. Our observations also support the hypothesis that chorioretinal changes occur at the edge of staphylomas and may predispose to choroidal neovasularisation.