{
  "abstract": "Purpose To determine whether posterior staphyloma (PS) is associated with long-term trajectories of ocular structural changes, myopia-related complications and visual outcomes in high myopia.Methods This prospective longitudinal cohort study included 614 highly myopic eyes from the Zhongshan High Myopia Cohort Study, followed for up to 12 years. Eyes were categorised by PS status: baseline PS (n=46), new-onset PS (n=94) or no PS (n=474). The associations between PS and myopic macular degeneration (MMD) progression, myopic traction maculopathy (MTM) and plus lesions incidence, longitudinal changes in ocular parameters and incident moderate-to-severe visual impairment (MSVI) were assessed.Results PS was independently associated with increased risks of MMD progression (OR 3.39, 95% CI 1.81 to 6.35, p<0.001), MTM (OR 2.25, 95% CI 1.06 to 4.77, p=0.034) and incident plus lesions (OR 3.15, 95% CI 1.16 to 8.57, p=0.024). The highest risks of MTM and plus lesions were observed in eyes with new-onset PS. Eyes with PS demonstrated significantly faster axial elongation (mean annual rate: baseline PS, 0.120 mm (95% CI 0.099 to 0.142); new-onset PS: 0.129 mm (95% CI 0.114 to 0.145); no PS: 0.066 mm (95% CI 0.060 to 0.073), p<0.001) and a fivefold higher risk of MSVI (95% CI 1.36 to 18.45, p=0.016).Conclusions PS marks a pivotal structural transition in high myopia, identifying a phase of accelerated axial elongation, increased risk of complications and worse visual outcomes, and may serve as a key marker for risk stratification and an important target for early intervention.",
  "authors": [
    {
      "affiliations": [
        "State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China",
        "Guangdong Basic Research Center of Excellence (GBRCE) for Major Blinding Eye Diseases Prevention and Treatment, Guangzhou, China"
      ],
      "name": "Yunqian Li"
    },
    {
      "affiliations": [
        "School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China",
        "Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Hong Kong, China",
        "Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong SAR, China"
      ],
      "name": "Shaoying Tan"
    },
    {
      "affiliations": [
        "State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China",
        "Guangdong Basic Research Center of Excellence (GBRCE) for Major Blinding Eye Diseases Prevention and Treatment, Guangzhou, China"
      ],
      "name": "Ruilin Xiong"
    },
    {
      "affiliations": [
        "State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China",
        "Guangdong Basic Research Center of Excellence (GBRCE) for Major Blinding Eye Diseases Prevention and Treatment, Guangzhou, China"
      ],
      "name": "Huangdong Li"
    },
    {
      "affiliations": [
        "State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China",
        "Guangdong Basic Research Center of Excellence (GBRCE) for Major Blinding Eye Diseases Prevention and Treatment, Guangzhou, China"
      ],
      "name": "Ziyu Zhu"
    },
    {
      "affiliations": [
        "State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China",
        "Guangdong Basic Research Center of Excellence (GBRCE) for Major Blinding Eye Diseases Prevention and Treatment, Guangzhou, China"
      ],
      "name": "Shida Chen"
    },
    {
      "affiliations": [
        "State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China",
        "Guangdong Basic Research Center of Excellence (GBRCE) for Major Blinding Eye Diseases Prevention and Treatment, Guangzhou, China",
        "Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Haikou, China"
      ],
      "name": "Wei Wang"
    }
  ],
  "title": "Posterior staphyloma and long-term structural and visual trajectories in high myopia",
  "uid": "d71ee5f5-91f9-5e3b-a53b-93affa6b1bd1"
}