Role of bruch's membrane opening area: a clinical indicator of the progression of macular defects in high myopia.

OBJECTIVE

To investigate the relationship between the morphology of the optic nerve head (ONH) region and macular Bruch’s membrane (BM) defects in patients with high myopia.

METHODS

This study included 77 individuals (77 eyes) who met the inclusion and exclusion criteria for retrospective analysis. According to the macular lesion pattern, the eyes were divided into group A (tessellated retina), group B (diffuse atrophy), and group C (macular BM defects). Demographic and ocular parameters, including age, axial length, ONH area, Bruch’s membrane opening (BMO) area, BMO/ONH area ratio, and posterior scleral morphology(PSM), were compared among the groups.

RESULTS

The mean ages of patients in Groups A, B, and C were 40.35 ± 14.87 years, 45.41 ± 12.82 years, and 48.58 ± 14.12 years, respectively, with no statistically significant difference among the groups (F = 2.546, P = 0.085). The axial lengths in Groups A, B, and C were 29.12 ± 1.70 mm, 30.48 ± 1.77 mm, and 30.72 ± 1.62 mm, respectively. The ONH areas were 2.45 ± 0.62 mm², 2.01 ± 0.77 mm², and 2.82 ± 0.73 mm², respectively. The BMO areas were 6.18 ± 3.27 mm², 8.40 ± 8.36 mm², and 14.08 ± 6.63 mm², with 95% confidence intervals (CIs) of 5.04–7.32 mm², 4.10–12.70 mm², and 11.40–16.75 mm², respectively. The BMO/ONH ratios were 2.55 ± 1.29, 3.89 ± 2.82, and 5.17 ± 2.44, respectively. Significant differences among the three groups were observed in axial length (F = 7.646, P = 0.001), ONH area (F = 7.174, P < 0.001), BMO area (F = 13.514, P < 0.001), and BMO/ONH ratio (F = 11.329, P = 0.001). However, posterior scleral morphology did not differ significantly among the groups (χ² = 3.2, P = 0.783). Multivariate analysis revealed that the Bruch’s membrane opening (BMO) area is the only factor significantly associated with macular lesions (AOR = 1.16, 95% CI: 1.04–1.32). ROC analysis showed that a BMO area of 9.04 mm² (AUC = 0.850, P < 0.001) was the optimal threshold for predicting macular BM defects.

CONCLUSIONS

BMO enlargement is associated with macular BM defects in highly myopic eyes. A BMO area greater than 9.04 mm² may serve as a predictor of macular BM defects.