Corneal biomechanical properties are associated with axial elongation. We aimed to characterize corneal biomechanical properties in highly myopic eyes with myopic maculopathy (MM).

Retrospective cross-sectional study.

We included patients examined between June 2022 and August 2023 who underwent corneal visualization Scheimpflug technology (Corvis ST) measurements. MM in highly myopic eyes (axial length >26.0 mm) was evaluated using META-PM (meta-analyses of pathologic myopia) study classification based on fundus photographs with subfoveal choroidal thickness measured via spectral domain optical coherence tomography. A linear mixed model was used to analyze the association of MM features with axial length (AL) and corneal biomechanical parameters, followed by model selection using the second-order–corrected Akaike information criterion.

We included 189 eyes from 109 participants. A significant correlation was observed between AL and biomechanical parameters that characterize maximal corneal deformation (maximal deflection amplitude and peak distance) and stiffness parameter (stress–strain index) (P < .05). Model selection revealed that both AL and maximal deflection amplitude were independently associated with MM with category ≥2 severe, as well as with subfoveal choroidal thickness in highly myopic eyes (AL >26.0 mm).

In highly myopic eyes, a greater maximal deflection amplitude was identified as a risk factor for MM. Corneal biomechanical properties may serve as biomarkers for predicting the development and progression of MM.