Choroidal Disorders in Staphyloma and Dome-Shaped Macula

Abstract

Posterior staphyloma is described as an ectasia of the limited area of the eyewall mostly in highly myopic eyes. Dome-shaped macula (DSM), detected by optical coherence tomography (OCT) is a convex elevation of the eyewall mostly in the posterior staphyloma area. Both posterior staphyloma and DSM are also rarely seen in eyes without high myopia. The process that begins with the axial enlargement of the Bruch’s membrane (BM) in the equatorial region during axial elongation and breaks in BM play a role in the pathogenesis. It is thought that DSM may be a kind of compensation mechanism in eyes with high myopia and posterior staphyloma. The choroidal layer is relatively thinner in staphyloma and thicker in KŞM. Multimodal imaging is may be required for diagnosis. In OCT, it is important to evaluate the vertical and horizontal scans together and not to keep the scanning area within the lesion boundaries. Attention should be paid to the changes in the posterior eye wall curvature and choroidal thickness. The gradual decrease of choroidal thickness from the periphery to the staphyloma border is an important tip for diagnosis. The fact that the increase in choroidal thickness is limited to the convex elevation area in DSM with serous macular detachment should be considered in differential diagnosis with central serous chorioretinopathy. Studies on increasing the biomechanical power of the sclera in staphyloma are ongoing. It may be a good option to avoid overtreatment in the presence of complications, considering the benefit-risk ratio.