Ultra-Widefield OCT Mapping of Foveal and Optic Nerve Head Topography Within Posterior Staphyloma in Pathologic Myopia.

OBJECTIVE: To define the spatial relationship between the fovea and optic nerve head (ONH), and to evaluate their associations with foveal complications and peripapillary atrophy in posterior staphyloma. DESIGN: Cross-sectional observational case series. PARTICIPANTS: Eyes with pathologic myopia and posterior staphyloma imaged with UWF-OCT at a single tertiary referral center. A total of 44 eyes of 25 patients were included. METHODS: All eyes underwent volumetric ultrawidefield (UWF) swept-source optical coherence tomography (OCT) using a 26 × 21 mm scan with 9.0 mm depth, allowing simultaneous visualization of the fovea, ONH, and posterior pole contour. The fovea and ONH were classified as located either at the staphyloma bottom or on the slope using combined 3-dimensional and cross-sectional analysis. Mixed-effects logistic regression was used to identify factors associated with foveal and ONH location, and a linear mixed-effects model was used to evaluate factors associated with peripapillary atrophy area. RESULTS: Forty-four eyes with three-dimensional UWF-SS-OCT volume datasets were reviewed. The fovea was more frequently located on the slope than at the bottom of the staphyloma, whereas the ONH was distributed more evenly between these regions. No significant associations were identified between foveal location and age, axial length, or staphyloma type. In contrast, greater axial length was independently associated with ONH location, with longer eyes showing a lower likelihood of ONH localization at the staphyloma bottom (odds ratio, 0.62; 95% confidence interval, 0.40-0.97; P = .036). Peripapillary atrophy was highly prevalent and was independently associated with both axial length (β = 1.54, P = .0105) and ONH location, with larger peripapillary atrophy area in eyes in which the ONH was located at the staphyloma bottom (β = 4.23, P = .0155). Local staphyloma configuration was not significantly associated with foveal complications. CONCLUSIONS: UWF-OCT showed that PS in pathologic myopia is a spatially heterogeneous posterior pole deformation in which the fovea and ONH may occupy different topographic compartments. Whereas foveal position appeared relatively independent of conventional clinical parameters, ONH location and peripapillary atrophy were associated with both axial elongation and local staphyloma geometry, supporting distinct macular and peripapillary remodeling mechanisms in pathologic myopia.