Title

Lacquer Cracks and Perforating Scleral Vessels in Pathologic Myopia: A Possible Causal Relationship

Publication Date

2015

Journal Title

Am J Ophthalmol

Abstract

PURPOSE: To describe a possible causal association between the position of perforating scleral vessels and the position of lacquer cracks in eyes with pathologic myopia. DESIGN: Retrospective case series. METHODS: Medical records and multimodal imaging results, including confocal scanning laser ophthalmoscopy and spectral-domain optical coherence tomography, were reviewed from patients with lacquer cracks secondary to pathologic myopia who presented between 2010 and 2014 to 2 institutions. Main outcome measures were the prevalence of perforating scleral vessels at the site of the lacquer crack, the position of the lacquer crack within the macula, and the relationships between perforating scleral vessels and retinal-choroidal structures. RESULTS: A total of 35 eyes of 30 patients with lacquer cracks were included. The average number of lacquer cracks was 1.2 +/- 0.5/eye and in 37 out of 45 lacquer cracks (82%) retrobulbar vessels were found to perforate the sclera at the site of the lacquer crack. Lacquer cracks were more prevalent in the central macula (51%) than in the nasal (19%), temporal (14%), inferior (11%), and superior macula (5%) (P = .001). Transverse en face images through the area of lacquer cracks were available for 8 cases and clearly depicted the perforating vessel's course through the sclera and its termination in the choroid, directly beneath the lacquer cracks. CONCLUSIONS: Perforating scleral vessels are often present beneath the site at which lacquer cracks form in pathologic myopia. We hypothesize that scleral expansion at the location of these perforating vessels may play a role in the formation of lacquer cracks.

Volume Number

160

Issue Number

4

Pages

759-66.e2

Document Type

Article

EPub Date

2015/07/26

Status

Northwell Researcher

Facility

Northwell Health

Primary Department

Ophthalmology

PMID

26209231

DOI

10.1016/j.ajo.2015.07.017