Revisiting pathologic myopia: imaging evidence of an inflammatory component in the pathogenesis of myopic degeneration

Pathologic myopia has traditionally been viewed as a degenerative disorder caused by mechanical stretching and choroidal ischemia. However, converging clinical, molecular, and imaging data increasingly suggest that chronic low-grade inflammation contributes to both the onset and progression of myopic retinal degeneration. Recent studies have identified inflammatory patterns-including multifocal choroiditis/punctate inner choroidopathy (MFC/PIC)-like lesions, periatrophic inflammatory "plumes," and secondary Multiple Evanescent White Dots Syndrome (MEWDS)-often localized at sites of retinal pigment epithelium-Bruch's membrane disruption. Parallel laboratory evidence indicates dysregulation of cytokines, activation of the complement cascade, and engagement of intracellular signaling pathways such as JAK-STAT within the myopic eye. Together, these findings support a model in which mechanical stress and hypoxia act as triggers for sustained immune activation, promoting extracellular-matrix remodeling, choroidal thinning, and progressive atrophy. Recognizing inflammation as an integral component of the pathophysiology of pathologic myopia may open new therapeutic perspectives, including immunomodulatory or complement-targeting approaches.