Paediatric staphyloma classification: new perspectives via ultrawide field three-dimensional swept-source optical coherence tomographic angiography

Aim To employ ultrawide field three-dimensional swept-source optical coherence tomographic angiography (UWF 3D SS-OCTA) modality, integrating novel strategies, posterior eye curvature maps and posterior eye height maps, in characterising the features and disease associations of posterior staphyloma in paediatric patients. This study seeks to compare paediatric staphylomas to established adult classifications, identify distinct paediatric patterns and introduce a new classification system for paediatric staphyloma using advanced multimodal imaging. Methods UWF 3D SS-OCTA imaging, integrating posterior eye curvature maps and posterior eye height maps strategies, was employed to analyse staphyloma presentations in the paediatric cohort. These data were then set against the traditionally established adult classifications. Additionally, the aetiology of staphylomas was investigated. Results The UWF 3D SS-OCTA modality, when integrated with posterior eye curvature maps and posterior eye height map, showcased superior imaging detail and better classification compared with UWF scanning laser ophthalmoscope, offering a more nuanced view of staphyloma patterns in paediatric patients. Specifically, only 54.7% of the paediatric cohort fit into previously recognised categories. The paediatric group displayed prominent temporal and inferior temporal staphylomas, likely linked to the high prevalence of peripheral vascular diseases. The study led to the proposal of five unique paediatric staphyloma classifications. Conclusions The UWF 3D SS-OCTA modality with posterior eye curvature maps and posterior eye height maps offers unparalleled insights into staphyloma patterns, especially in paediatric patients. Paediatric staphylomas exhibit a unique presentation, divergent from adults, with two novel types identified. The findings underline the importance of updating classification systems, ensuring they reflect the realities observed in paediatric pathology and diagnostics.