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Odette M. Houghton, Veronica K. Kon-Jara, Jan N. Ulrich, Maurice B. Landers; Topographic Features of Optical Coherence Tomography and Three-dimensional Model of Dome-shaped Macula. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4434.
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To correlate the anatomical and morphologic features of the posterior globe with the pathophysiology in eyes with dome-shaped macula (DSM).
Cross-sectional Study: Twelve eyes of 7 patients with high myopia and DSM were identified through a review of spectral-domain optical coherence tomography (OCT) images. Each patient had undergone a complete ophthalmological evaluation. The morphology of the retina, choroid and sclera were studied with OCT, enhanced depth imaging (EDI-) OCT, fluorescein angiogram (FA) and B-scan ultrasonography examinations. A 3-dimensional model of the posterior staphyloma in these patients was created based on an analysis of B-scan ultrasonography images. Outcome measures included visual acuity (VA), preservation of the external limiting membrane (ELM), photoreceptor inner and outer segment (IS/OS) junction integrity and type of posterior staphyloma.
The study cohort consisted of 5 women and 2 men with a mean age of 50 years (range, 33 to 65 years). The mean refractive error was -14.33 diopters (D) (range -9.25 to -22.00 D). The VA ranged from 20/20 to 20/200. Bilateral DSM was present in 5 out of 7 patients. Two of these patients had bilateral neurosensory retinal detachments (NSD). One patient with unilateral DSM had NSD. Two eyes had disruption of the ELM. The VA was 20/200 in each eye without an intact ELM. Five eyes had disruption of the IS/OS junction. Discontinuity of the ELM and IS/OS junction was associated with NSD in all cases. The VA of eyes with intact ELM and disruption of the IS/OS junction ranged from 20/30 to 20/60. The FA revealed no evidence of leakage in any patient. Two patients with the presence of NSD had been treated with half-fluence photodynamic therapy (PDT). PDT resulted in resolution of the subretinal fluid without a change in VA in both cases. Two patients with the presence of NSD were treated with anti-vascular endothelial growth factor (VEGF) without a decrease of subretinal fluid or improvement in VA. The average choroidal and scleral thickness of the "dome" was 70 μm and 530 μm respectively. The 3-dimensional model of the posterior staphyloma revealed a morphology distinct from previously described classifications of staphyloma.
DSM may present with or without NSD. In those patients who develop NSD the VA may not be severely impacted if the ELM is intact. Treatment with anti-VEGF agents do not appear efficacious, whereas PDT appears to resolve the NSD. In addition to the localized alteration in scleral and choroidal architecture, DSM appears to be associated with a unique form of staphyloma. Further studies are required to improve our understanding of the natural history and pathophysiology of DSM.
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