Evolution of Macular Bruch Membrane Defects of Patchy Chorioretinal Atrophy in Pathologic Myopia Based on a Recent Classification System

Abstract

<b><i>Purpose:</i></b> The purpose of this study was to analyze the progression of macular Bruch membrane defects (BMD) in highly myopic patients with patchy atrophy (PA); and study its correlation with the enlargement of PA and ATN grading. <b><i>Setting/Venue:</i></b> Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain. <b><i>Patients and Methods:</i></b> This was a cross-sectional, noninterventional study. A series of 451 highly myopic eyes with spherical equivalent &#x3e; −6.0 D and/or &#x3e;26 mm of axial length (AL) were included. All patients underwent a complete ophthalmological examination and swept-source optical coherence tomography (SS-OCT), and were graded using the ATN system by 2 masked retina experts that assessed the atrophic (A), tractional (T), and neovascular (N) components. SS-OCT b-scans were employed to study PA and macular BMD at baseline and at a 1-year follow-up, in patients with good foveal fixation. <b><i>Results:</i></b> Out of total 451 eyes, 126 eyes (27.9%) had PA (53 patients; 75.4% women). Mean T and N in eyes with PA were 1.1 ± 1.3 and 0.08 ± 0.2, respectively. Sixty-eight of them had &#x3e;1-year follow-up with a good foveal fixation and enough image quality. From them, BMD were found in 44 eyes (64.7%) at baseline and increased to 59 eyes (86.7%) at a 1-year follow-up. The mean great linear dimension of PA and macular BMD increased with a median of 384.5 ± 462.5 μm (IR 68.0–660.2) and 265.6 ± 418.1 μm (IR 0–331.7), respectively. At 1-year, PA and BMD sizes increase, and were statistically significant (<i>p</i> &#x3c; 0.001). There was a positive correlation between the growth of macular BMD and the growth of PA (<i>r</i> = 0.490, <i>p</i> &#x3c; 0.00). T grading correlated significantly with PA growth (<i>p</i> &#x3c; 0.05). <b><i>Conclusions:</i></b> Macular BMD increase its prevalence and its size over time in highly myopic patients with PA. There is a positive correlation between BMD and PA area growth. New studies with a larger sample size, longer follow-up, and AL elongation correlation are necessary to corroborate our findings.