Dome-shaped Macula Research Articles

LONG-TERM EVOLUTION OF DOME-SHAPED MACULA: Increased Macular Bulge is Associated With Extended Macular Atrophy.

Dome-shaped macula (DSM) may cause impaired vision. This study analyzed the long-term evolution of DSM, most particularly macular changes: serous retinal detachment, retinal pigment epithelium atrophy, and DSM bulge increase. Twenty-nine eyes presenting with DSM were retrospectively studied. Clinical data, color photographs, fluorescein angiographs, and optical coherence tomography examinations were reviewed. Patients were followed up from 6 months to 111 months (mean, 37.89 months). The height of the macular bulge, the size of retinal pigment epithelium macular atrophy, and serous retinal detachment progression were studied. Other macular changes were noted. Mean vision remained stable. Dome-shaped macula height increased significantly from 338.9 μm to 364.3 μm (P = 0.007). Serous retinal detachment was present initially in 15 of 29 eyes; it increased in 4 cases and resolved spontaneously in 7. Macular retinal pigment epithelium atrophy correlated with the bulge height (P = 0.015), and it enlarged during follow-up (1.12 vs. 1.34, P = 0.04). Other macular anomalies were present initially or appeared during follow-up: macular pucker, choroidal neovascularization (CNV), subretinal pigmentary clumps, and flat irregular pigmented epithelium detachment. A few treatments were proven in serous retinal detachment cases but were ineffective in restoring vision. In DSM, vision may be stable for years while macular changes progress: the macular bulge increases as does retinal pigment epithelium atrophy.

Advances of optical coherence tomography in myopia and pathologic myopia.

The natural course of high-axial myopia is variable and the development of pathologic myopia is not fully understood. Advancements in optical coherence tomography (OCT) technology have revealed peculiar intraocular structures in highly myopic eyes and unprecedented pathologies that cause visual impairment. New OCT findings include posterior precortical vitreous pocket and precursor stages of posterior vitreous detachment; peripapillary intrachoroidal cavitation; morphological patterns of scleral inner curvature and dome-shaped macula. Swept source OCT is capable of imaging deeper layers in the posterior pole for investigation of optic nerve pits, stretched and thinned lamina cribrosa, elongated dural attachment at posterior scleral canal, and enlargement of retrobulbar subarachnoid spaces. This has therefore enabled further evaluation of various visual field defects in high myopia and the pathogenesis of glaucomatous optic neuropathy. OCT has many potential clinical uses in managing visual impairing conditions in pathologic myopia. Understanding how retinal nerve fibers are redistributed in axial elongation will allow the development of auto-segmentation software for diagnosis and monitoring progression of glaucoma. OCT is indispensable in the diagnosis of various conditions associated with myopic traction maculopathy and monitoring of post-surgical outcomes. In addition, OCT is commonly used in the multimodal imaging assessment of myopic choroidal neovascularization. Biometry and topography of the retinal layers and choroid will soon be validated for the classification of myopic maculopathy for utilization in epidemiological studies as well as clinical trials.

Prevalence of macular complications associated with high myopia by multimodal imaging

To describe the prevalence of macular complications in patients with visual acuity decrease related to high myopia (HM). To establish correlations between these complications and demographic or anatomical characteristics. Cross-sectional observational study including HM patients undergoing best-corrected visual acuity (BCVA), fundus examination, macular SD-OCT, and fluorescein angiography in the case of suspicion of choroidal neovascularization (CNV). The presence of anatomical criteria (staphyloma, subfoveal choroidal thickness [CT]) and macular complications (CNV, lacquer cracks, central chorioretinal atrophy, dome-shaped macula with serous retinal detachment [SRD], retinal foveoschisis, macular hole and epiretinal membrane) was investigated. A total of 87eyes of 47patients were included (39eyes without macular complication and 48eyes with macular complications). In the case of macular complications, decrease in BCVA was related to CNV in 33%, macular hole in 25%, chorioretinal atrophy in 19%, foveoschisis in 11%, lacquer crack in 6%, to a dome-shape macula with serous retinal detachment in 4% and epiretinal membrane in 2%. After adjusting for interocular correlation and degree of myopia, staphyloma (P=0.0023), choroidal thinning (P=0.0036), and extrafoveal chorioretinal atrophy (P=0.042) were significantly associated with macular complications. High myopic patients with staphyloma or choroidal thinning should undergo regular comprehensive retinal screening for retinal complications.

Serous Retinal Detachment Associated with Dome-Shaped Macula and Staphyloma Edge in Myopic Patients before and after Treatment with Spironolactone.

Objective. Serous retinal detachment (SRD) is a common anatomical complication associated with dome-shaped macula (DSM) and staphyloma margin in myopic patients. Here we described the anatomical and functional outcomes obtained with the use of oral spironolactone, a mineralocorticoid antagonist, in the management of myopic patients with SRD associated with DSM and staphyloma margin. Methods. We evaluated both eyes of twelve myopic patients with long-standing SRD associated with DSM or staphyloma margin. The patients were treated daily for six months with oral spironolactone 50 mg. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT), determined by optical coherence tomography, were evaluated on the first day and on monthly follow-up visits. Results. Pretreatment BCVA (mean ± standard deviation) was 0.406 ± 0.324 LogMAR, and posttreatment BCVA was 0.421 ± 0.354 LogMAR (P = 0.489). Pretreatment CRT was 323.9 ± 78.6 μm, and after six months of treatment it was significantly lower, 291.2 ± 74.5 μm (P = 0.010). There were no treatment-related complications. Conclusions. We evaluated a novel treatment for SRD associated with DSM and staphyloma margin in myopic patients. After six months of treatment with the mineralocorticoid antagonist spironolactone, the subretinal fluid and CRT were significantly reduced; however, there was no improvement in BCVA.

Clinical Characteristics of Posterior Staphylomas in Myopic Eyes With Axial Length Shorter Than 26.5 Millimeters

To describe the features of posterior staphylomas in myopic eyes with an axial length shorter than 26.5mm causing visual loss in old age. Retrospective, observational case series. After reviewing cases of staphyloma, we isolated 16 eyes from 10 patients with an axial length <26.5mm for further analysis. These patients had all undergone fundus photography and spectral-domain optical coherence tomography (SDOCT) and some had undergone 3-dimensional magnetic resonance imaging (3D-MRI). The mean age of the patients was 70.0 ± 6.3 years (mean ± standard deviation; range 59-81). The mean axial length of the eyes with a posterior staphyloma was 25.14 ± 0.77mm and the mean refractive error of the affected eyes was-4.28 ± 2.65 diopters. The median visual acuity was 20/60. All eyes presented with diffuse chorioretinal atrophy, which resembles pathologic myopic maculopathy. Fuchs spots previously were detected in 3 eyes (19%) and lacquer cracks in 2 (12%). SDOCT imaging of the macula showed decreased choroidal thickness in all eyes. A macular retinoschisis was detected in 5 eyes (31%), decreased ellipsoid zone reflectivity in 4 (25%), foveal retinal detachment in 2 (12%), a dome-shaped macula in 1 (6%), a choroidal neovascularization-related subretinal scar in 3 (19%), and loss of ellipsoid zone and outer nuclear layer in 3 (19%). The 3D-MRI scans from 8 eyes showed posterior staphylomas, lateral angulation, or protrusion in all eyes. No eye featured a tilted disc syndrome. Posterior staphylomas in myopic eyes with an axial length shorter than 26.5mm exhibit features resembling pathologic myopic maculopathy. This type of staphyloma might cause visual impairment in elderly patients and can be considered atypical forms ofpathologic myopia in old age.

Comparison of Clinical Features in Highly Myopic Eyes with and without a Dome-Shaped Macula

To compare the clinical features of highly myopic eyes with a dome-shaped macula (DSM) with those without a DSM and to identify the funduscopic clues to suspect the presence of DSM. Retrospective case series. A total of 586 patients (1118 eyes) with high myopia (refractive error <-8 diopters [D] or axial length ≥26.5 mm) who had optical coherence tomography (OCT) examinations through the central fovea at our High Myopia Clinic between February 2012 and November2013. Vertical and horizontal OCT scans across the central fovea were retrospectively analyzed. A DSM was defined by the presence of an inward bulge of >50 μm in the vertical OCT image. Fundus photographs also were analyzed to identify the funduscopic clues to suspect the presence of DSM. The rate of DSM in 1118 highly myopic eyes. The rate of DSM in highly myopic eyes with macular complications. Funduscopic features to suggest the presence of DSM. Among the 1118 eyes, 225 (20.1%) had a DSM. A DSM was present in both vertical and horizontal OCT sections in 20% of eyes, along only the vertical section in 77% of eyes, and in only the horizontal section in 2% of eyes. The results of multiple regression analyses showed that serous retinal detachment and foveal and extrafoveal retinoschisis were significantly associated with the presence of DSM and that choroidal neovascularization was not. Ophthalmoscopically, 91.4% of the eyes with the appearance of a horizontal ridge connecting the optic disc and the fovea had a DSM. A DSM is found in as many as 20% of highly myopic individuals. Horizontal ridges connecting the optic disc and the fovea might be an important clue to suspect the presence of a DSM on the basis of fundus photographs.

Considering photodynamic therapy as a therapeutic modality in selected cases of dome-shaped macula complicated by foveal serous retinal detachment.

To study the role of photodynamic therapy (PDT) as a therapeutic modality in myopic patients with dome-shaped macula (DSM) associated with foveal serous retinal detachment (SRD). Retrospective interventional case series. The medical records of 10 consecutive myopic patients (10 eyes) with DSM associated with subfoveal SRD and treated with PDT were reviewed. Visual gain and loss were considered as increasing or decreasing of two or more lines of best corrected visual acuity (BCVA), respectively, and eyes with fluid resolution were deemed responsive to PDT. All eyes underwent several PDT treatments, with a median of three and a median follow-up time of 15.5 months. At final follow-up, six eyes (60%) showed complete resolution of the foveal SRD. The baseline hypocyanescent macular area observed during late indocyanine green angiography (ICGA) frames was significantly lower in the group of patients who responded to PDT and had an increase of at least two Snellen lines in BCVA (P = .01). Data suggest that myopic eyes associated with DSM and foveal SRD may be responsive to PDT, showing total resolution of fluid accumulation and positive BCVA changes if baseline ICGA findings show evidence of a limited hypocyanescent macular area.

Bilateral Dome-Shaped Macula with Serous Macular Detachment in a Child.

Dome-shaped macula is a structural disorder and optical coherence tomography (OCT) helps us to confirm macular convexity. We describe the first case of bilateral dome-shaped macula in an 8-year-old boy with subretinal fluid. The patient was diagnosed using spectral-domain OCT and received indocyanine green angiography-guided half-fluence photodynamic therapy as treatment.

Choroidal Findings in Dome-Shaped Macula in Highly Myopic Eyes: A Longitudinal Study

To describe choroidal findings in dome-shaped macula associated with high myopia using fluorescein angiography (FA), indocyanine green angiography (ICGA), and spectral-domain optical coherence tomography (SD OCT), and to elucidate the mechanism and natural course of serous retinal detachment (RD) associated with dome-shaped macula. Retrospective, observational case series. We reviewed longitudinal imaging results of 52 highly myopic eyes with dome-shaped macula. Changes on FA and ICGA were assessed. Retinal, choroidal, and scleral thicknesses and bulge height were measured on SD OCT. Serous RD was the most common abnormality associated with dome-shaped macula, detected by SD OCT in 44% of the cases with no associated choroidal neovascularization. Significant differences in the proportion of eyes with pinpoint leakage on FA (P < .001), punctate hypercyanescence on ICGA (P < .001), and pigment epithelium detachment on SD OCT (P < .001) were noted inside the inward bulge of the staphyloma between eyes with and without serous RD. Serous RD was not associated with hyperpermeability areas on ICGA. Eyes with serous RD had thicker choroid (P = .004) and tended to have thicker sclera (P = .067) and greater bulge height (P = .079). Choroidal thickness, scleral thickness, and bulge height were positively correlated (P < .01). All eyes presented a fluctuating course of serous RD during follow-up. Worsening of serous RD was associated with appearance of new punctate hypercyanescent spots on ICGA and leaking points on FA (P < .001 and P = .016, respectively). Serous RD in dome-shaped macula was likely caused by choroidal vascular changes, similar to central serous chorioretinopathy, but specifically confined in the inward bulge of the staphyloma and secondary to excessive scleral thickening. Serous retinal detachment showed fluctuating changes over time, with alternating active and inactive stages. Angiographic findings in dome-shaped macula suggest the choroid as a target for possible treatment strategies.

Visual Acuity Outcome in RADIANCE Study Patients With Dome-Shaped Macular Features

Recently, dome-shaped macula (DSM) has been described in patients with pathologic myopia. The DSM has been identified in optical coherence tomography (OCT) scans, fundus biomicroscopy, and ultrasonography, and is characterized by an inward bulge inside the chorioretinal posterior concavity of the eye in macular area.1 The pathophysiology of DSM is not known precisely, but several theories have been published. These include localized choroidal thickening, scleral infolding, and vitreo-macular traction.

Décollement séreux maculaire sur macula bombée

Décollement séreux maculaire sur macula bombée

Resolution of foveal detachment in dome-shaped macula after treatment by spironolactone: report of two cases and mini-review of the literature.

Dome-shaped macula (DSM) was recently described in myopic patients as a convex protrusion of the macula within a posterior pole staphyloma. The pathogenesis of DSM and the development of associated serous foveal detachment (SFD) remain unclear. The obstruction of choroidal outflow and compressive changes of choroidal capillaries have been proposed as causative factors. In this paper, we report two cases of patients with chronic SFD associated with DSM treated with oral spironolactone. After treatment, there was a complete resolution of SFD in both patients. To the best of our knowledge, this is the first report of successful treatment of SFD in DSM by a mineralocorticoid receptor antagonist.

Morphologic Characteristics of Macular Complications of a Dome-Shaped Macula Determined by Swept-Source Optical Coherence Tomography

To investigate the morphologic characteristics of macular complications of dome-shaped maculas using swept-source optical coherence tomography (OCT). Retrospective observational case series. Axial length measurements and swept-source OCT were performed in 49 highly myopic eyes (in 5 male and 30 female subjects) with dome-shaped maculas. We classified the dome patterns and measured the central retinal thickness, central choroidal thickness, central scleral thickness, and the macular bulge height, and assessed the associations of these parameters with macular complications. The central scleral thickness was significantly negatively correlated with age and the axial length. We classified the eyes into 3 groups: 6 with choroidal neovascularization (CNV group), 8 with retinal pigment epithelial detachment (PED group; 5 with serous retinal detachment), and 35 with no complications (no complications group). Nine eyes had a round dome and 40 had horizontally oriented oval-shaped domes. There were no significant differences in the frequency of macular complications between these patterns. The CNV group was significantly older and had a longer axial length than the other groups. The PED group had significantly larger values for both the central scleral thickness and bulge height than the other groups. The central choroidal thickness was significantly thinner in the CNV group than in the no complications group. A dome-shaped macula results from relative thickening of the macular sclera, and this may lead to PED. Thinning of the sclera owing to long-term changes and elongation of the axis may develop CNV and cause visual impairment.

Épaisseur choroïdienne fovéolaire au SD-OCT dans la myopie forte avec macula bombée

To measure macular choroidal thickness (CT) using spectral-domain optical coherence tomography (SD-OCT) in highly myopic eyes with dome-shaped macula (DSM), and to investigate whether the choroid is thicker in these eyes compared to highly myopic eyes without MB. A cross-sectional study of 200 eyes was performed between January 2010 and June 2012. Twenty-four highly myopic eyes (12%) had a dome-shaped macula. All patients underwent a complete ophthalmological examination, SD-OCT (TOPCON 2000), and B-scan ultrasonography. OCT scans were analyzed in 7 sections, and subfoveal CT was measured manually between the Bruch's membrane and the internal aspect of the sclera. The 20 eyes with isolated dome-shaped macular were paired by age and axial length (AL) with 20 eyes without macular involvement. In the subgroup with isolated MB, the mean subfoveal CT was 101.86 μm (± 21.35 μm). A statistically significant negative correlation was found between CT and AL (r=-0.623, P=0.0001). The regression equation demonstrated a decrease of 8.3 μm per mm of AL. In the subgroup without MB, matched with the subgroup with MB by age (P=0.591), and AL (P=0.815), the mean subfoveal CT was 89.54 μm (± 20.12 μm). The comparison between the two subgroups found a statistically significant difference in subfoveal CT (P<10-4). In our study, choroidal thickness is increased in highly myopic eyes with dome-shaped macula compared to highly myopic eyes without dome-shaped macula. These findings suggest that abnormalities of the choroid may play a role in the pathogenesis of dome-shaped macula.

The extended clinical phenotype of dome-shaped macula

To describe the phenotype, associations, and complications of dome-shaped macula (DSM) through the combination of spectral-domain optical coherence tomography (OCT) imaging and B-scan ultrasonography, when available. This retroprospective cohort study aims to gain further pathophysiological understanding in eyes with DSM. Fifty-eight eyes of 36 patients were identified as having OCT features of DSM. Retinal and choroidal thicknesses were determined from enhanced depth imaging (EDI)-OCT image sets, with scleral thickness subsequently calculated by subtraction from the B-scan ultrasound-derived measurements of posterior coat thickness. DSM was associated with myopia in 81% of eyes. The underlying clinical diagnosis was variable: central serous chorioretinopathy (CSCR)-like entity, choroidal neovascularization, and inherited retinal disorders. The subfoveal choroidal thickness of the nine highly myopic eyes with a CSCR-like phenotype was thicker than the 25 eyes without CSCR (p = 0.169). The mean subfoveal scleral thickness of the highly myopic eyes was 585 ± 196μm, which was significantly different from those with a refractive error less than 6 diopters (1133 ±290μm) (P < 0.0001). This study highlights the novel observation of a thickened choroid when CSCR is present. In addition, we expand the associations of DSM to eyes with hypermetropia and acquired disease, and to those with inherited retinal dystrophies.

Spontaneous resolution of foveal detachment in dome-shaped macula observed by spectral domain optical coherence tomography

Dome-shaped macula (DSM) was described by Gaucher et al as a convex protrusion of macula within a staphyloma in highly myopic eyes that causes visual impairment associated with serous foveal detachment (SFD). We describe a patient with spontaneous resolution of SFD in DSM documented by serial spectral domain optical coherence tomography (SD-OCT). A 28-year-old female Japanese patient presented with blurred vision in both eyes. Upon examination, her best-corrected visual acuity was 1.2 with −8.0 sphere and 0.5 with −8.0 sphere in the right and left eyes, respectively. SD-OCT in both eyes showed an anterior bulge of the macula with SFD. The diagnosis of DSM with SFD was made on the basis of characteristic findings. Three months later, the patient achieved spontaneous resolution of SFD without treatment. One month later, there was an occurrence of SFD in the right eye, but the SFD had disappeared in 1 month. In our case, her visual impairment was proven to be a consequence of SFD in relation to DSM. SD-OCT was useful for the detection and follow-up of SFD in DSM.

Treatment of Subretinal Fluid Associated With Dome-Shaped Macula

Dome-shaped macula is a recently described disorder seen in eyes with myopic posterior staphyloma. Vision loss may accompany sub-macular fluid accumulation, for which no effective treatment has been reported. The authors report the successful treatment of two female patients, aged 34 and 59 years, with chronic exudative macular detachment associated with dome-shaped macula. Symptoms of subretinal fluid had been present for at least 2 years in each case, and the fluid was refractory to multiple intravitreal bevacizumab injections in one eye. After a single session of half-fluence verteporfin photodynamic therapy, the submacular fluid resolved completely in each eye. In one eye, recurrent submacular fluid 2 years later responded partially to repeat photodynamic therapy and completely to focal laser photocoagulation. [Ophthalmic Surg Lasers Imaging Retina. 2013;44:593-595.].

Morphologic Characterization of Dome-Shaped Macula in Myopic Eyes With Serous Macular Detachment

To analyze dome-shaped maculas topographic features and related serous retinal detachment (SRD) in eyes with myopic staphyloma. Retrospective, observational case series. We reviewed the records of 48 eyes in 33 patients with dome-shaped maculas who were referred because of decreased vision. Ophthalmologic examination included axial length measurement, spectral domain optical coherence tomography (OCT), and fluorescein and indocyanine green angiography. The height of the macular bulge was measured, and the choroidal thickness was mapped. Patient mean age was 55.0 ± 13.6 years. Mean axial length was 27.49 ± 2.53mm. Mean best-corrected visual acuity (BCVA) was 0.50 ± 0.33 logMAR. Three dome-shaped macula patterns were observed: round dome in 10/48 (20.8%) eyes; horizontal oval-shaped dome in 30/48 (62.5%) eyes; and vertical oval-shaped dome in 8/48 (16.7%) eyes. The mean macular bulge height was 407.7 ± 215.1μm (120-1130) and was significantly greater in vertical oval-shaped domes. The mean central choroidal thickness (CCT) was 146.5 ± 56.0μm, significantly greater than at 3mm nasal and temporal to the fovea (P < 0.0001). The CCT was positively correlated to macular bulge height but not to BCVA. Foveal SRD was present in 25/48 eyes and significantly increased for macular bulge height greater than 350μm (P= 0.0047). BCVA was significantly lower when SRD was present (P= 0.043). Most dome-shaped maculas did not display a round but a horizontal or vertical oval-shaped dome and could be missed on a single OCT scan. Chronic foveal SRD was associated with decreased vision and was more common when the macular bulge was highly elevated.

Macula en dôme : aspects échographique et tomographique

The purpose of our work is to demonstrate the role of optical coherence tomography and ocular ultrasound in the diagnosis of the dome-shaped macula in high myopia.We report the case of a patient with high myopia who presented with a decrease in visual acuity and metamorphopsia in the left eye. She underwent visual acuity measurement, biomicroscopic examination and measurement of axial length. B-mode ultrasound and optical coherence tomography showed a projection of the macula in the convexity of the myopic staphyloma confirming the diagnosis of dome-shaped macula.Dome-shaped macula is a recently discovered entity, which may be responsible for a decrease in visual acuity in patients with high myopic posterior staphyloma. Ultrasound and optical coherence tomography are very helpful in making the diagnosis.

Three-Dimensional Tomographic Features of Dome-Shaped Macula by Swept-Source Optical Coherence Tomography

To study the tomographic and pathomorphologic features of dome-shaped maculas with swept-source optical coherence tomography (OCT). Prospective, cross-sectional study. The macular area of 51 highly myopic eyes (35 patients) with dome-shaped maculas was studied with swept-source OCT at 1050nm. Three-dimensional (3-D) data sets were obtained with raster scanning covering a 12× 8-mm(2) area; 3-D images of the posterior pole were constructed by autosegmentation of the retinal pigment epithelium (RPE). In all reconstructed 3-D images of the RPE, 2 outward concavities were seen within the posterior staphyloma and a horizontal ridge was formed between these 2 concavities. In 42 of these eyes, this horizontal ridge was band shaped. The vertical OCT section through the fovea showed a convex configuration of RPE, but the horizontal section showed an almost flat RPE line. In 9eyes, 3-D images showed a typical dome-shaped convexity within the staphyloma. OCT scans showed no outward protrusions in the external scleral surface, but marked scleral thinning was seen consistent with the 2 outward concavities of the RPE. The sclera of the fovea (518.6 ± 97.6μm) was significantly thicker than that in all 4 quadrants of the parafoveal area (range, 277.2 to 360.3μm; P< .001). In highly myopic eyes with a dome-shaped macula, a horizontal ridge is formed within the posterior staphyloma by uneven thinning of the sclera.