title: Lacquer Cracks and Perforating Scleral Vessels in Pathologic Myopia: A Possible Causal Relationship.
abstract: OBJECTIVE
  To describe a possible causal association between the position of perforating scleral vessels and the position of lacquer cracks in eyes with pathologic myopia.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Medical records and multimodal imaging results, including confocal scanning laser ophthalmoscopy and spectral-domain optical coherence tomography, were reviewed from patients with lacquer cracks secondary to pathologic myopia who presented between 2010 and 2014 to 2 institutions. Main outcome measures were the prevalence of perforating scleral vessels at the site of the lacquer crack, the position of the lacquer crack within the macula, and the relationships between perforating scleral vessels and retinal-choroidal structures.
  
  
  RESULTS
  A total of 35 eyes of 30 patients with lacquer cracks were included. The average number of lacquer cracks was 1.2 ± 0.5/eye and in 37 out of 45 lacquer cracks (82%) retrobulbar vessels were found to perforate the sclera at the site of the lacquer crack. Lacquer cracks were more prevalent in the central macula (51%) than in the nasal (19%), temporal (14%), inferior (11%), and superior macula (5%) (P = .001). Transverse en face images through the area of lacquer cracks were available for 8 cases and clearly depicted the perforating vessel's course through the sclera and its termination in the choroid, directly beneath the lacquer cracks.
  
  
  CONCLUSIONS
  Perforating scleral vessels are often present beneath the site at which lacquer cracks form in pathologic myopia. We hypothesize that scleral expansion at the location of these perforating vessels may play a role in the formation of lacquer cracks.
authors.affiliation: Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milan, Italy; Department of Ophthalmology, Hopital Intercommunal de Creteil, University Paris Est Creteil, Creteil, France. Electronic address: giuseppe.querques@hotmail.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Querques
authors.affiliation: Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Corvi
authors.affiliation: Vitreous Retina Macula Consultants of New York, New York, New York; Department of Ophthalmology, New York University School of Medicine, New York, New York; Department of Physiology ad Pharmacology, Centre for Ophthalmology and Visual Sciences, Lions Eye Institute, University of Western Australia, Perth, Australia.
authors.forename: Chandrakumar
authors.initials: C
authors.lastname: Balaratnasingam
authors.affiliation: Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Casalino
authors.affiliation: Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Maurizio Battaglia
authors.initials: MB
authors.lastname: Parodi
authors.affiliation: Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: Introini
authors.affiliation: Vitreous Retina Macula Consultants of New York, New York, New York; Department of Ophthalmology, New York University School of Medicine, New York, New York.
authors.forename: K Bailey
authors.initials: KB
authors.lastname: Freund
authors.affiliation: Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, University Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bandello
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D064847:Multimodal Imaging; D047728:Myopia, Degenerative / Q000150:complications*; D009887:Ophthalmoscopy; D012164:Retinal Diseases / Q000175:diagnosis / Q000209:etiology*; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D012590:Sclera / Q000098:blood supply* / Q000473:pathology; D015422:Scleral Diseases / Q000175:diagnosis / Q000209:etiology*; D041623:Tomography, Optical Coherence