Quantitative Analysis of Posterior Staphyloma Using Foveal Angulation: Relationship to Leftover Astigmatism in Pseudophakic Eyes

Purpose To describe a method of measuring the amount of angulation of the foveal region of the macula in eyes with posterior staphyloma (PS) and then to determine whether or not those eyes manifest a refractive astigmatism as a result of the PS. Methods Pseudophakic eyes with an axial length (AL) of 25 mm or greater were included in this retrospective study. Using vector analysis, “leftover astigmatism” (LOA) was calculated by subtracting total keratometric astigmatism (TKA) as measured with the IOLMaster 700 (Carl Zeiss Meditec AG) from the manifest refractive astigmatism (MRA) after vector subtraction of the astigmatic effect of a toric IOL, if present. The amount of LOA was analyzed to determine its relationship, if any, to the angulation of the fovea as measured by optical coherence tomography. Results A total of 92 eyes of 58 patients (average age: 71.4 years) were enrolled. Eyes were separated into groups based on the degree of foveal angulation. No correlation was found ( P > .05) between the amount of LOA and the degree of foveal angulation between all groups. There was no significant difference in LOA between the non-staphyloma (foveal angulation 10 degrees or less) and staphyloma (foveal angulation 11 degrees or greater) groups ( P > .05), regardless of the amount of foveal angulation that was present. Conclusions Foveal angulation can be used to objectively measure PS, a condition that does not contribute to refractive astigmatism. [ J Refract Surg . 2025;41(7):e667–e673.]