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

Features of the choriocapillaris in myopic maculopathy identified by optical coherence tomography angiography

“…These prevalence rates are higher than those reported previously by Ohno-Matsui et al and Querques et al presumably because of the different devices used and patient inclusion criteria between the current and previous reports. We believe that intrascleral vessels are common in eyes with myopic maculopathy, represent scleral stretching and are related to the pathogenesis of the myopic maculopathy as Querques et al 22 suggested. In addition, interestingly, no intrascleral vessels had flow signals on en-face OCT images with angiographic overlays even in the area of the patchy atrophy.…”

“…Ohno-Matsui et al 21 first described intrascleral vessels using swept-source OCT. Querques et al 22 later observed the intrascleral vessels using spectral-domain OCT and reported that these vessels might be related to the pathogenesis of the lacquer cracks. Ohno-Matsui et al 21 reported that the parts of the large blood vessels seen within the area of patchy atrophy by ICGA were not the choroidal vessels but the intrascleral vessels.…”

Possible connection of short posterior ciliary arteries to choroidal neovascularisations in eyes with pathologic myopia

“…Querques et al 23 reported that the perforation sites of the retrobulbar scleral-perforating vessels were present in the areas of lacquer cracks. This suggested a possible relationship between the scleral vessels and the lesions of myopic maculopathy.…”

Three-Dimensional Analysis of Submacular Perforating Scleral Vessels by Enhanced Depth Imaging Optical Coherence Tomography

“…Perforating scleral vessels have been implicated in the pathogenesis of structural changes of the sclera as investigated by OCT and reported by Pedinielli et al 10 and Ohno-Matsui et al 11 More recently, Querques et al 12 reported on the formation of lacquer cracks in pathologic myopia. Assessed by indocyanine green angiography angiography, Moriyama et al 18 found a lower number of PCAs and a displacement of the entry site in highly myopic eyes compared with controls.…”

“…Multiple sectorial watershed zones meet in the submacular region, presumably making the macula and the avascular zone of the fovea vulnerable to ischemia under certain conditions. 9 Perforating scleral vessels (PSVs) have been visualized as linear hyporeflective structures at the level of the sclera by EDI-SDOCT and swept-source OCT in pathologic myopia as reported by Pedinielli et al 10 and Ohno-Matsui et al 11 More recently, perforating scleral vessels have been investigated in connection with lacquer cracks in pathologic myopia by Querques et al 12 They have been hypothesized to act as "locus minoris resistentiae," leading to scleral expansion and lacquer crack formation. Because of low signal-to-noise ratio, the visualization of PSVs in emmetropic eyes has been more problematic to date.…”