Extended Clinical Phenotype of Dome-Shaped Macula

Abstract

Purpose: To describe the phenotype, associations and complications of dome-shaped macula with the use of spectral domain optical coherence tomography (OCT) scan and B scan ultrasound.

Methods: Fifty-eight eyes of 36 patients were retrospectively identified as having OCT features of dome-shaped macula (DSM). All subjects had undergone enhanced depth imaging (EDI) OCT choroidal imaging as part of the scanning protocol. Fifteen patients underwent a B scan ultrasound to determine axial length and posterior coat thickness. Choroidal thickness and retinal thickness was determined with OCT, with scleral thickness subsequently calculated by subtraction from the ultrasound derived posterior coat thickness.

Results: Dome-shaped macula was associated with myopia (81 %). The underlying clinical diagnosis was variable, including: central serous chorioretinopathy (CSCR)-like entity (32.7%), chorioretinal neovascularization (CNV) (20.7%), and inherited retinal disorders (19%). The subfoveal choroidal thickness of the 9 highly myopic eyes with a CSCR-like phenotype (239 ± 144µm) was thicker than the 25 eyes without CSCR (153 ± 161µm) (p=0.169).

Conclusions: This study confirms the previous finding in highly myopic eyes with dome-macula of the presence of local scleral thickening and in addition the novel observation of a thickened choroid if CSCR is present. The observation of the thickened choroid may have therapeutic implications. We also expand the associations of dome-shaped macula to include eyes with hypermetropia and acquired disease, and also inherited retinal disease.

Keywords: 688 retina • 550 imaging/image analysis: clinical • 605 myopia