Fathimath Jila Shameem
Introduction
Posterior staphyloma (PS) is an outpouching of a circumscribed region in posterior fundus and has been considered as a hallmark feature of pathologic myopia (1). Posterior staphyloma can occur in non-highly myopic eyes, such as retinitis pigmentosa, tilted disc syndrome, etc. and has been reported in associated with trauma or infection (2). Pathologic myopia refers to ocular complications of high myopia (severe near-sightedness), which increase the risk of vision-threatening complications (2).
Posterior staphyloma is linked to a variety of vision-threatening complications due to stretching of the posterior fundus. These include myopic choroidal neovascularisation, chorioretinal atrophy, macular retinoschisis, and macular holes (3,4).
This article provides a concise overview of posterior staphyloma.
Pathophysiology
The exact pathogenesis of posterior staphyloma is unknown. It is thought to result from the progressive scleral thinning and collagen disorganisation caused by axial elongation in high myopia (1). Histological studies show associated choroidal thinning and occasional defects in Bruch’s membrane, particularly at the staphyloma edge (1).
Classification of Posterior Staphyloma
Using three-dimensional MRI and wide-field fundus imaging, Ohno-Matsui classified posterior staphylomas into six types: wide macular, narrow macular, peripapillary, nasal, inferior, and other complex configurations (1). This classification builds upon Curtin’s earlier system, which described ten staphyloma types, comprising five primary forms (Types I–V) and five compound forms (Types VI–X) (3).
Imaging
Posterior staphyloma is primarily diagnosed based on multimodal imaging. Traditionally, posterior staphylomas were identified using indirect ophthalmoscope, B-scan ultrasound, 45 – 50 ° fundus photo, and occasionally computed tomography (CT) or magnetic resonance imaging (MRI), which provided limited two-dimensional views and poor differentiation between ocular layers (1,4).On stereoscopic fundus, posterior staphyloma appears as “a slight excavation around optic disc” (4,5)
Three-dimensional MRI was a major advancement in the assessment of posterior staphyloma, as it enabled visualisation of the entire globe and analysis of the whole eye (1,4). However, its routine clinical use is limited by cost, availability, and relatively low spatial resolution, which makes subtle or shallow staphylomas difficult to detect (1,4).
In contrast, modern swept-source OCT (SS-OCT) and wide-field OCT provide superior resolution and better tissue differentiation, enabling detailed assessment of ocular layers and may replace 3D MRI in routine diagnosis (1,4,5).
On wide-field OCT, posterior staphyloma demonstrates three characteristic features: gradual choroidal thinning from the periphery towards the staphyloma edge, outward scleral protrusion posterior to the staphyloma edge and inward protrusion of sclera at the staphyloma edge (4,6).
Management
Due to the unclear pathogenesis, there is no gold-standard treatment for posterior staphyloma (1). Management focuses on monitoring disease progression through regular OCT and fundus imaging follow-up and on treating associated complications. Anti-VEGF therapy for myopic choroidal neovascularization, while vitrectomy for traction maculopathy (1). There are no treatments available for myopic chorioretinal atrophy and Bruch’s membrane holes (1).
Various methods of reshaping the sclera in posterior staphyloma have been explored. Posterior scleral reinforcement to strengthen the posterior eyewall, but its role remains controversial (7). Scleral cross-linking to stiffen the sclera and fibroblast transplantation to reduce ocular elongation have shown promising results (4).
References
1. Ohno-Matsui K, Jonas JB. Posterior staphyloma in pathologic myopia. Prog Retin Eye Res [Internet]. 2019 May 1 [cited 2025 Dec 10];70:99–109. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1350946218300697
2. Flores-Moreno I, Puertas M, Ruiz-Medrano J, Almazán-Alonso E, García-Zamora M, Ruiz-Moreno JM. Influence of posterior staphyloma in myopic maculopathy and visual prognosis. Eye [Internet]. 2023 Jan 1 [cited 2025 Dec 10];38 (1):145. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10764733/
3. Curtin BJ. The posterior staphyloma of pathologic myopia. Trans Am Ophthalmol Soc [Internet]. 1977 [cited 2025 Dec 14];75:67. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC1311542/
4. Ehongo A. Understanding Posterior Staphyloma in Pathologic Myopia: Current Overview, New Input, and Perspectives. Clin Ophthalmol [Internet]. 2023 [cited 2025 Dec 10];17:3825. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10725704/
5. Shinohara K, Shimada N, Moriyama M, Yoshida T, Jonas JB, Yoshimura N, et al. Posterior Staphylomas in Pathologic Myopia Imaged by Widefield Optical Coherence Tomography. Invest Ophthalmol Vis Sci [Internet]. 2017 Jul 1 [cited 2025 Dec 12];58 (9):3750–8. Available from: https://pubmed.ncbi.nlm.nih.gov/28738419/
6. Hsiang HW, Ohno-Matsui K, Shimada N, Hayashi K, Moriyama M, Yoshida T, et al. Clinical Characteristics of Posterior Staphyloma in Eyes with Pathologic Myopia. Am J Ophthalmol. 2008;146 (1).
7. Li X J, Yang X P, Li Q M, Wang Y Y, Wang Y, Lyu X B, et al. Posterior scleral reinforcement for the treatment of pathological myopia. Int J Ophthalmol [Internet]. 2016 Apr 18 [cited 2025 Dec 12];9 (4):580–4. Available from: https://pubmed.ncbi.nlm.nih.gov/27162733/