Ultra-Widefield Optical Coherence Tomographic Imaging of Posterior Vitreous in Eyes With High Myopia

•Ultra-widefield OCT can visualize posterior vitreous (23 mm wide and 5 mm deep). •Posterior vitreous detachments progress asymmetrically in highly myopic eyes. •Posterior staphyloma and scleral curvature associated with vitreous detachment. •Posterior vitreous adheres to retinal vessels at multiple points. •Vitreous traction spanning a wide distance may lead to myopic traction maculopathy. Purpose To investigate the morphological changes of posterior vitreous in highly myopic (HM) eyes of patients 50 years of age and older. Design Retrospective, observational case series. Methods Ultra-widefield swept-source OCT (UWF-OCT) examinations were performed on 768 eyes of 448 HM patients (50-89 years of age) and 54 eyes of 52 non-HM subjects with scan widths of 23 mm and depths of 5 mm. HM was defined as an axial length longer than 26.5 mm. The area and morphology of the posterior vitreous detachments (PVDs) and adhesions onto retinal vessels were examined for in 167 HM eyes and in 11 non-HM eyes in which the vitreal images were clear. Results Paramacular PVD, perifoveal PVD, peripapillary PVD, and complete PVD were found in 9%, 47%, 41%, and 3% of the 167 HM eyes, respectively, and in 37%, 45%, 18%, and 0% of the 11 non-HM eyes, respectively. In eyes with vitreofoveal adhesions, the PVDs were more commonly asymmetrical relative to the fovea in the HM eyes than in the non-HM eyes (94% vs. 44%, respectively; P < .001). The area of the PVD corresponded with the area where the sclera protruded posteriorly. A thickened vitreous was observed to adhere to the retinal vessels at multiple points and was accompanied by paravascular abnormalities including lamellar holes in HM eyes. A total of 54 of the 167 HM eyes had macular retinoschisis, and the eyes commonly had vitreal traction on retinal vessels compared to HM eyes without macular retinoschisis (P = .031). Conclusions PVD progressed asymmetrically and were associated with scleral curvature in HM eyes. Vitreous traction spanning a wide distance may lead to myopic traction maculopathy. To investigate the morphological changes of posterior vitreous in highly myopic (HM) eyes of patients 50 years of age and older. Retrospective, observational case series. Ultra-widefield swept-source OCT (UWF-OCT) examinations were performed on 768 eyes of 448 HM patients (50-89 years of age) and 54 eyes of 52 non-HM subjects with scan widths of 23 mm and depths of 5 mm. HM was defined as an axial length longer than 26.5 mm. The area and morphology of the posterior vitreous detachments (PVDs) and adhesions onto retinal vessels were examined for in 167 HM eyes and in 11 non-HM eyes in which the vitreal images were clear. Paramacular PVD, perifoveal PVD, peripapillary PVD, and complete PVD were found in 9%, 47%, 41%, and 3% of the 167 HM eyes, respectively, and in 37%, 45%, 18%, and 0% of the 11 non-HM eyes, respectively. In eyes with vitreofoveal adhesions, the PVDs were more commonly asymmetrical relative to the fovea in the HM eyes than in the non-HM eyes (94% vs. 44%, respectively; P < .001). The area of the PVD corresponded with the area where the sclera protruded posteriorly. A thickened vitreous was observed to adhere to the retinal vessels at multiple points and was accompanied by paravascular abnormalities including lamellar holes in HM eyes. A total of 54 of the 167 HM eyes had macular retinoschisis, and the eyes commonly had vitreal traction on retinal vessels compared to HM eyes without macular retinoschisis (P = .031). PVD progressed asymmetrically and were associated with scleral curvature in HM eyes. Vitreous traction spanning a wide distance may lead to myopic traction maculopathy.