Perivascular Chorioretinal Atrophy: an Unusual Feature in Pathologic Myopia Eyes

Purpose: To describe a new feature in pathologic myopia: perivascular patchy chorioretinal atrophy (PVCA) DESIGN: Cross-sectional study METHODS: 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).

Results: 47 eyes (7.8%) of 32 patients presented with 88 PVCA lesions in total. Mean age was 65.9 ± 10.2 years, mean best corrected visual acuity (BVCA) was 0.86 LogMAR ± 0.76. All patients had posterior staphyloma, with PVCA localized within the staphyloma (58%), on its margins (39%), or outside 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 µm ± 152. PVCA patients had longer AL (32.94mm ± 1.87 vs. 29.96mm ± 2.79; p<0.01) than non-PVCA patients. When compared to matched control PVCA patients had lower BCVA (0.86LogMAR ± 0.76 vs. 0.59LogMAR ± 0.71; p=0.01) and reduced macular choroidal thickness (38µm ± 31 vs. 54µm ± 38; p=0.02).

Conclusion: 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.