Abstract
PurposeTo examine an association between macular Bruch’s membrane defects (MBMD) and a dome-shaped appearance of the macula (DSM).DesignRetrospective, observational case series study.MethodsThe study included highly myopic individuals who were consecutively examined between May 2014 and December 2015. The patients underwent swept-source optical coherence tomography (OCT) for visualization of DSM and MBMDs defined as Bruch´s membrane defects located at a distance of maximal 1500 μm from the foveola.ResultsOut of 1983 highly myopic eyes (1057 patients), 166 eyes (8.4%; 95% confidence interval (CI):7.2%,9.6%)) showed a DSM and 534 eyes showed a MBMD. In multivariate binary regression analysis, higher prevalence of DSM was associated with a higher prevalence of a MBMD (P<0.001; OR: 1.96; 95%CI: 1.40, 2.75) after adjusting for longer axial length (P<0.001; odds ratio (OR): 1.27; 95%CI: 1.16, 1.38). In eyes with a DSM partially surrounded by a MBMD, the retina, retinal pigment epithelium (RPE) and choroid appeared relatively unchanged in the central region with Bruch´s membrane (BM) preserved. In the ring-like BM-free region surrounding the central prominent island of the DSM, the RPE, the outer and middle retinal layers, the choriocapillaris and the middle-sized choroidal vessel layer were absent. In association with a DSM, three MBMD types were differentiated: MBMDs in patchy chorioretinal atrophy, MBMDs in choroidal neovascularization-related macular atrophy, and MBMDs as temporally extending large parapapillary gamma zone.ConclusionsPresence of a DSM was significantly associated with the presence of MBMDs. The morphology of the DSM in association with MBMDs may be associated with a focal relaxation of the posterior sclera, no longer pushed outward by an expanding BM but allowed to partially bulge inward, leading to the formation of a DSM.
Highlights
Dome-shaped macula (DSM) is an inward protrusion of the macula as visualized by optical coherence tomography (OCT).[1, 2] Imamura, Spaide and coworkers reported that a dome-shaped appearance of the macula (DSM) was associated with, and caused by, a local thickening of the subfoveal sclera.[3]
In multivariate binary regression analysis, higher prevalence of DSM was associated with a higher prevalence of a macular Bruch’s membrane defects (MBMD) (P
In eyes with a DSM partially surrounded by a MBMD, the retina, retinal pigment epithelium (RPE) and choroid appeared relatively unchanged in the central region with Bruchs membrane (BM) preserved
Summary
Dome-shaped macula (DSM) is an inward protrusion of the macula as visualized by optical coherence tomography (OCT).[1, 2] Imamura, Spaide and coworkers reported that a DSM was associated with, and caused by, a local thickening of the subfoveal sclera.[3] It was postulated that the local thickening of the subfoveal sclera was an adaptive or compensatory response to the defocus of the image on the fovea in highly myopic eyes. [8] defects of BM in the macular region were recently in a histological study of highly myopic eyes.[9] These macular BM defects (MBMDs) were accompanied by a complete loss of RPE and choriocapillaris and an almost complete loss of the outer and middle retinal layers and of the middle-sized choroidal vascular layer. This BM free region, which can be visualized by OCT, has been called parapapillary gamma zone.[12]
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