What does the arrow point to in the fundus examination of a myopic patient?
Fundus findings in degenerative myopia:1A pale tessellated ('tigroid') appearance is due to diffuse attenuation of the RPE with visibility of large choroidal vessels.2Focal chorioretinal atrophy is characterized by the visibility of the larger choroidal vessels and eventually the sclera.3Anomalous optic nerve head which may appear unusually small, large or anomalous with a 'tilted' conformation. Peripapillary chorioretinal atrophy is very common, and in milder cases taking the form of a temporal crescent of thinned or absent RPE exposing the choroid and/or sclera.4'Lacquer cracks' are ruptures in the RPE-Bruch membrane-choriocapillaris complex characterized clinically by fine, irregular, yellow lines, often branching and crisscrossing at the posterior pole. They are present in around 5% of highly myopic eyes and can precede the development of CNV, retinal hemorrhages without CNV, and geographic atrophy. It is thought that the flaw in the RPE barrier constituted by the cracks provides a route through which choriocapillaris tissue can grow.5Lattice degeneration.6Subretinal 'coin' hemorrhages, which may be intermittent, may develop from lacquer cracks in the absence of CNV.7A Fuchs spot is a raised, circular, pigmented lesion at the macula developing after a subretinal hemorrhage has absorbed.8A staphyloma is an ectasia or bulging of the posterior sclera due to focal expansion and thinning. It occurs in about a third of eyes with pathological myopia, and is viually always peripapillary or involves the macula. Staphyloma development can be associated with macular hole formation.Ref: Kanski; 7th edition; Pg. 637
FosterFuchs spot
Lacquer cracks
Arlt line
Myopic crescent
Vitreous and retina