{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:25:42Z","timestamp":1760149542139,"version":"build-2065373602"},"reference-count":51,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2023,8,15]],"date-time":"2023-08-15T00:00:00Z","timestamp":1692057600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Topcon, Co."}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>The purpose of this study was to examine bilaterality and symmetry of posterior staphyloma (PS) in high myopic eyes. Methods: This cross-sectional and non-interventional study assessed 473 high myopic eyes [axial length (AL) \u2265 26 mm] of 259 patients. Patients underwent an ophthalmological examination including multimodal-imaging and myopic maculopathy grading according to Atrophic\/Tractional\/Neovascular (ATN) system, presence and subtype of PS, and severe pathologic myopia (PM). Bilaterality of PS and subtype\u2019s symmetry between eyes of the same patient was assessed. Four groups were analyzed: (1) bilateral vs. unilateral PS\u2019s eyes. Within bilateral group, symmetric vs. asymmetric subtypes according to (2) Curtin\u2019s classification, (3) Ohno-Matsui\u2019s classification, and (4) primary\/compound subtypes. Results: Out of the total, 334 myopic eyes of 167 patients were included. The 92.8% (n = 310\/334) of the eyes presented PS and was bilateral in 85.6% (n = 143\/167) of the patients. Bilateral eyes showed significantly (p &lt; 0.01) greater AL, severe PM, A and N components vs. unilateral PS. AL-difference between both eyes was greater in unilateral PS (p &lt; 0.01). Among bilateral PS, the subtype was symmetric in 79 (55.2%), 84 (58.7%), and 115 (80.4%) patients according to Curtin\u2019s classification, Ohno-Matsui\u2019s classification, and primary\/compound; respectively. The asymmetric group presented worse best-corrected visual acuity (p &lt; 0.01), higher AL (p &lt; 0.01), incidence of PM, and severe PM (p &lt; 0.05). Conclusions: PS was bilateral in most of the patients without clinical differences between both eyes, being symmetrical in more than half of bilateral cases. Patients with bilateral PS showed higher myopic maculopathy, AL, and incidence of severe PM than unilateral PS.<\/jats:p>","DOI":"10.3390\/diagnostics13162680","type":"journal-article","created":{"date-parts":[[2023,8,15]],"date-time":"2023-08-15T11:09:44Z","timestamp":1692097784000},"page":"2680","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Analysis of Bilaterality and Symmetry of Posterior Staphyloma in High Myopia"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9636-0788","authenticated-orcid":false,"given":"Jos\u00e9 M.","family":"Ruiz-Moreno","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Puerta de Hierro-Majadahonda University Hospital, 28222 Madrid, Spain"},{"name":"Department of Ophthalmology, Castilla La Mancha University, 02001 Albacete, Spain"},{"name":"Miranza Corporation, 28004 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5557-6822","authenticated-orcid":false,"given":"Mariluz","family":"Puertas","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Puerta de Hierro-Majadahonda University Hospital, 28222 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4236-514X","authenticated-orcid":false,"given":"Ignacio","family":"Flores-Moreno","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Puerta de Hierro-Majadahonda University Hospital, 28222 Madrid, Spain"},{"name":"Cl\u00ednica Su\u00e1rez Leoz, 28010 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Almaz\u00e1n-Alonso","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Puerta de Hierro-Majadahonda University Hospital, 28222 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3716-4992","authenticated-orcid":false,"given":"Mar\u00eda","family":"Garc\u00eda-Zamora","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Puerta de Hierro-Majadahonda University Hospital, 28222 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1105-9265","authenticated-orcid":false,"given":"Jorge","family":"Ruiz-Medrano","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Puerta de Hierro-Majadahonda University Hospital, 28222 Madrid, Spain"},{"name":"Miranza Corporation, 28004 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Spaide, R.F. (2014). Pathologic Myopia, Springer.","DOI":"10.1007\/978-1-4614-8338-0"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1167\/iovs.62.4.5","article-title":"IMI Pathologic Myopia","volume":"62","author":"Wu","year":"2021","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_3","unstructured":"Cadell, T., and Davies, W. (1806). Practical Observations on the Principal Diseases of the Eyes: Illustrated with Cases, Besleys Books."},{"key":"ref_4","first-page":"67","article-title":"The Posterior Staphyloma of Pathologic Myopia","volume":"75","author":"Curtin","year":"1977","journal-title":"Trans. Am. Ophthalmol. Soc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1626","DOI":"10.1016\/j.ophtha.2011.01.018","article-title":"Topographic Analyses of Shape of Eyes with Pathologic Myopia by High-Resolution Three-Dimensional Magnetic Resonance Imaging","volume":"118","author":"Moriyama","year":"2011","journal-title":"Ophthalmology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1798","DOI":"10.1016\/j.ophtha.2014.03.035","article-title":"Proposed Classification of Posterior Staphylomas Based on Analyses of Eye Shape by Three-Dimensional Magnetic Resonance Imaging and Wide-Field Fundus Imaging","volume":"121","year":"2014","journal-title":"Ophthalmology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1016\/j.ajo.2015.01.022","article-title":"International Photographic Classification and Grading System for Myopic Maculopathy","volume":"159","author":"Kawasaki","year":"2015","journal-title":"Am. J. Ophthalmol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1016\/j.ophtha.2017.12.005","article-title":"Progression of Myopic Maculopathy during 18-Year Follow-Up","volume":"125","author":"Fang","year":"2018","journal-title":"Ophthalmology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1595","DOI":"10.1016\/j.ophtha.2009.11.003","article-title":"Long-Term Pattern of Progression of Myopic Maculopathy: A Natural History Study","volume":"117","author":"Hayashi","year":"2010","journal-title":"Ophthalmology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.preteyeres.2018.12.001","article-title":"Posterior Staphyloma in Pathologic Myopia","volume":"70","author":"Jonas","year":"2019","journal-title":"Prog. Retin. Eye Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1016\/j.ophtha.2018.01.035","article-title":"Ten-Year Progression of Myopic Maculopathy: The Beijing Eye Study 2001\u20132011","volume":"125","author":"Yan","year":"2018","journal-title":"Ophthalmology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"8763","DOI":"10.1167\/iovs.11-8195","article-title":"Morphologic Choroidal and Scleral Changes at the Macula in Tilted Disc Syndrome with Staphyloma Using Optical Coherence Tomography","volume":"52","author":"Maruko","year":"2011","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1097\/IAE.0000000000002180","article-title":"Posterior Staphylomas in Eyes with Retinitis Pigmentosa Without High Myopia","volume":"39","author":"Xu","year":"2019","journal-title":"Retina"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1007\/s10792-006-9012-y","article-title":"Progressive Myopia Due to Posterior Staphyloma in Type I Osteogenesis Imperfecta","volume":"26","author":"Scott","year":"2005","journal-title":"Int. Ophthalmol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.preteyeres.2015.12.001","article-title":"Updates of Pathologic Myopia","volume":"52","author":"Lai","year":"2016","journal-title":"Prog. Retin. Eye Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.ajo.2023.02.017","article-title":"Posterior Staphyloma as Determining Factor for Myopic Maculopathy","volume":"252","author":"Puertas","year":"2023","journal-title":"Am. J. Ophthalmol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1016\/S0161-6420(01)01024-7","article-title":"Prevalence and Progression of Myopic Retinopathy in an Older Population","volume":"109","author":"Vongphanit","year":"2002","journal-title":"Ophthalmology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e144","DOI":"10.1111\/aos.14527","article-title":"Prevalence, Risk Factors and Impact of Posterior Staphyloma Diagnosed from Wide-Field Optical Coherence Tomography in Singapore Adults with High Myopia","volume":"99","author":"Zheng","year":"2021","journal-title":"Acta Ophthalmol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1177\/112067219700700313","article-title":"Relationship between Retinal Lesions and Axial Length, Age and Sex in High Myopia","volume":"7","author":"Sezen","year":"1997","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.ajo.2008.03.010","article-title":"Clinical Characteristics of Posterior Staphyloma in Eyes with Pathologic Myopia","volume":"146","author":"Hsiang","year":"2008","journal-title":"Am. J. Ophthalmol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.preteyeres.2018.10.005","article-title":"Myopic Maculopathy: Current Status and Proposal for a New Classification and Grading System (ATN)","volume":"69","author":"Montero","year":"2019","journal-title":"Prog. Retin. Eye Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2113","DOI":"10.1097\/IAE.0000000000002725","article-title":"Validation of the Recently Developed ATN Classification and Grading System for Myopic Maculopathy","volume":"40","author":"Cheung","year":"2020","journal-title":"Retina"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1867","DOI":"10.1097\/IAE.0000000000003129","article-title":"Correlation between ATN Grade for Myopic Maculopathy and Clinical Severity","volume":"41","author":"Cheung","year":"2021","journal-title":"Retina"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.sapharm.2012.04.004","article-title":"Interrater Agreement and Interrater Reliability: Key Concepts, Approaches, and Applications","volume":"9","author":"Gisev","year":"2013","journal-title":"Res. Soc. Adm. Pharm."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"159","DOI":"10.2307\/2529310","article-title":"The Measurement of Observer Agreement for Categorical Data","volume":"33","author":"Landis","year":"1977","journal-title":"Biometrics"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.ajo.2011.01.052","article-title":"Long-Term Development of Significant Visual Field Defects in Highly Myopic Eyes","volume":"152","author":"Shimada","year":"2011","journal-title":"Am. J. Ophthalmol."},{"key":"ref_27","first-page":"312","article-title":"Axial Length Measurements and Fundus Changes of the Myopic Eye. I. The Posterior Fundus","volume":"68","author":"Curtin","year":"1970","journal-title":"Trans. Am. Ophthalmol. Soc."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.preteyeres.2017.09.004","article-title":"The Epidemics of Myopia: Aetiology and Prevention","volume":"62","author":"Morgan","year":"2018","journal-title":"Prog. Retin. Eye Res."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Guan, H., Yu, N.N., Wang, H., Boswell, M., Shi, Y., Rozelle, S., and Congdon, N. (2019). Impact of Various Types of near Work and Time Spent Outdoors at Different Times of Day on Visual Acuity and Refractive Error among Chinese School-Going Children. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0215827"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Curtin, B.J. (1985). The Myopias: Basic Science and Clinical Management, Harper and Row.","DOI":"10.1097\/00006982-198600620-00013"},{"key":"ref_31","unstructured":"Ohno-Matsui, K., and Moriyama, M. (2014). Pathologic Myopia, Springer."},{"key":"ref_32","unstructured":"Hosaka, A. (1987). Myopia, Kanehara Shuppan."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.ajo.2009.04.029","article-title":"Enhanced Depth Imaging Optical Coherence Tomography of the Choroid in Highly Myopic Eyes","volume":"148","author":"Fujiwara","year":"2009","journal-title":"Am. J. Ophthalmol."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Spaide, R.F. (2014). The Choroid. Pathol. Myopia, 113\u2013131.","DOI":"10.1007\/978-1-4614-8338-0_9"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1428","DOI":"10.1097\/IAE.0000000000001464","article-title":"Bruch membrane and the mechanism of myopization: A New Theory","volume":"37","author":"Jonas","year":"2017","journal-title":"Retina"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1111\/aos.12372","article-title":"Bruch\u2032s Membrane Thickness in High Myopia","volume":"92","author":"Jonas","year":"2014","journal-title":"Acta Ophthalmol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e664","DOI":"10.1111\/aos.13027","article-title":"Secondary Bruch\u2032s Membrane Defects and Scleral Staphyloma in Toxoplasmosis","volume":"94","author":"Jonas","year":"2016","journal-title":"Acta Ophthalmol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e856","DOI":"10.1111\/aos.14405","article-title":"Histology of Myopic Posterior Scleral Staphylomas","volume":"98","author":"Jonas","year":"2020","journal-title":"Acta Ophthalmol."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Fang, Y., Jonas, J.B., Yokoi, T., Cao, K., Shinohara, K., and Ohno-Matsui, K. (2017). Macular Bruch\u2019s Membrane Defect and Dome-Shaped Macula in High Myopia. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0178998"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/0002-9394(86)90817-2","article-title":"A 48-Year Clinical and Epidemiologic Study of Keratoconus","volume":"101","author":"Kennedy","year":"1986","journal-title":"Am. J. Ophthalmol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.clae.2007.03.001","article-title":"Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study: Methods and Findings to Date","volume":"30","author":"Wagner","year":"2007","journal-title":"Cont. Lens Anterior Eye"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.clae.2010.04.006","article-title":"Keratoconus: A Review","volume":"33","author":"Wolffsohn","year":"2010","journal-title":"Contact Lens Anterior Eye"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1097\/00003226-200210000-00008","article-title":"Between-Eye Asymmetry in Keratoconus","volume":"21","author":"Zadnik","year":"2002","journal-title":"Cornea"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1136\/bjo.2003.034520","article-title":"The Relation between Disease Asymmetry and Severity in Keratoconus","volume":"88","author":"Nichols","year":"2004","journal-title":"Br. J. Ophthalmol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1252","DOI":"10.1136\/bjo.2003.033670","article-title":"Keratoconus: An Analysis of Corneal Asymmetry","volume":"88","author":"Burns","year":"2004","journal-title":"Br. J. Ophthalmol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1038\/ng.2554","article-title":"Genome-Wide Meta-Analyses of Multiancestry Cohorts Identify Multiple New Susceptibility Loci for Refractive Error and Myopia","volume":"45","author":"Verhoeven","year":"2013","journal-title":"Nat. Genet."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1038\/s41588-018-0127-7","article-title":"Genome-Wide Association Meta-Analysis Highlights Light-Induced Signaling as a Driver for Refractive Error","volume":"50","author":"Tedja","year":"2018","journal-title":"Nat. Genet."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1038\/s41588-020-0599-0","article-title":"Meta-Analysis of 542,934 Subjects of European Ancestry Identifies New Genes and Mechanisms Predisposing to Refractive Error and Myopia","volume":"52","author":"Hysi","year":"2020","journal-title":"Nat. Genet."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1782","DOI":"10.1038\/s41467-018-03649-3","article-title":"CCDC102B Confers Risk of Low Vision and Blindness in High Myopia","volume":"9","author":"Hosoda","year":"2018","journal-title":"Nat. Commun."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Miyake, M., Yamashiro, K., Akagi-Kurashige, Y., Oishi, A., Tsujikawa, A., Hangai, M., and Yoshimura, N. (2014). Analysis of Fundus Shape in Highly Myopic Eyes by Using Curvature Maps Constructed from Optical Coherence Tomography. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0107923"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Cases, O., Joseph, A., Obry, A., Santin, M.D., Ben-Yacoub, S., P\u00e2ques, M., Amsellem-Levera, S., Bribian, A., Simonutti, M., and Augustin, S. (2015). Foxg1-Cre Mediated Lrp2 Inactivation in the Developing Mouse Neural Retina, Ciliary and Retinal Pigment Epithelia Models Congenital High Myopia. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0129518"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/16\/2680\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:33:53Z","timestamp":1760128433000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/16\/2680"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,15]]},"references-count":51,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2023,8]]}},"alternative-id":["diagnostics13162680"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13162680","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2023,8,15]]}}}