Longitudinal follow-up of dome-shaped macula

IMI Pathologic Myopia

Pathologic myopia is a major cause of visual impairment worldwide. Pathologic myopia is distinctly different from high myopia. High myopia is a high degree of myopic refractive error, whereas pathologic myopia is defined by a presence of typical complications in the fundus (posterior staphyloma or myopic maculopathy equal to or more serious than diffuse choroidal atrophy). Pathologic myopia often occurs in eyes with high myopia, however its complications especially posterior staphyloma can also occur in eyes without high myopia.

Owing to a recent advance in ocular imaging, an objective and accurate diagnosis of pathologic myopia has become possible. Especially, optical coherence tomography has revealed novel lesions like dome-shaped macula and myopic traction maculopathy. Wide-field optical coherence tomography has succeeded in visualizing the entire extent of large staphylomas. The effectiveness of new therapies for complications have been shown, such as anti-VEGF therapies for myopic macular neovascularization and vitreoretinal surgery for myopic traction maculopathy.

Myopia, especially childhood myopia, has been increasing rapidly in the world. In parallel with an increase in myopia, the prevalence of high myopia has also been increasing. However, it remains unclear whether or not pathologic myopia will increase in parallel with an increase of myopia itself. In addition, it has remained unclear whether genes responsible for pathologic myopia are the same as those for myopia in general, or whether pathologic myopia is genetically different from other myopia.

Evolution of Dome-shaped Macula Is Due to Differential Elongation of the Eye Predominant in the Peri-dome Region

PURPOSE

To determine the mechanism behind macular bulge height increase in eyes with dome-shaped macula (DSM).

DESIGN

Retrospective, observational case series.

METHODS

Eyes presenting with DSM followed up for a minimum of 1 year were examined using ocular biometry and spectral-domain optical coherence tomography at baseline and at end of follow-up. Axial length (AL), DSM bulge height, and central and peripheral choroidal thickness (nasal, temporal, superior, and inferior quadrants) were reported. Eyes were categorized into 2 groups for comparison: the "mini-DSM" group (DSM < 100 μm) and the "classic" DSM group (DSM > 100 μm).

RESULTS

Fifty-eight eyes (33 patients) were studied: 32 (55%) were classic DSM and 26 (45%) mini-DSM. During the mean follow-up of 51.76 ± 36.01 months, mean AL increased from 26.99 ± 2.94 mm to 27.12 ± 3.09 mm (P = .010) and mean macular bulge height increased from 235.88 ± 282.47 μm to 262.34 ± 317.15 μm (P < .001). DSM height change was significantly higher than AL change (P < .001). Mean peripheral choroidal thickness significantly decreased nasally (P = .008), temporally (P = .026), and inferiorly (P < .001). Mini-DSM eyes exhibited shorter AL (26.17 vs 27.66 mm; P = .027), greater visual acuity (0.169 vs 0.437 logMAR; P = .002), and fewer macular complications compared to classic DSM eyes.

CONCLUSIONS

Macular bulge increase in DSM is associated with eye elongation and overall thinning of the peripheral choroid. DSM might result from differential elongation of the eye predominant in the peri-dome region. Mini-DSM (ie, inferior to 100 μm) are characterized by slower evolution, better visual prognosis, and fewer complications compared to "classic" DSM.

Spectral-Domain Optical Coherence Tomography-Based Morphofunctional Characterization of Dome-Shaped Maculopathy in Indian Population

Purpose. To study the clinicodemographic profile of dome-shaped maculopathy (DSM) eyes in the Indian population and characterization using spectral-domain optical coherence tomography (SD-OCT). Methods. This observational cross-sectional study included 25 eyes of 14 patients diagnosed with DSM. All eyes underwent SD-OCT for characterization of the dome profile and also to measure central macular thickness (CMT), subfoveal choroidal thickness (SFCT), and dome height (DH) and to detect the presence of subretinal fluid (SRF). Results. The mean age of patients was 48.36 ± 14.23 years (range, 28–65 years). Eleven patients had bilateral involvement. Mean axial length of all eyes was 24.25 ± 1.95 mm and mean spherical equivalent −4.23 ± 3.79 DS. Overall, 11/25 eyes (44%) had round domes, 9/25 eyes (36%) had horizontal domes, and 5/25 eyes (20%) had vertical domes, with a mean dome height at fovea of 500.54 ± 291.58 µm. Vertical domes had higher DH compared to horizontal or combined domes $\left(p=0.02\right)$ . Six eyes (6/25, 24%) showed the presence of SRF; 60% of vertical domes had SRF, and 22.2% of horizontal domes had SRF. The eyes having SRF had significantly higher CMT $\left(p=0.017\right)$ and DH $\left(p=0.001\right)$ , especially in horizontal domes $\left(p=0.023\right)$ . The eyes with thicker SFCT tended to have higher DH and poorer visual acuity. Conclusion. Indian DSM eyes may have relatively lesser amounts of myopia. Choroidal thickening may play a role in development of DSM and may also be related to development of subretinal fluid in such eyes.