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Violaine Caillaux, David Gaucher, Vincent Gualino, Pascale Massin, Ramin Tadayoni, Alain Gaudric; Morphological description of dome-shaped macula in myopic eyes. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2819.
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© ARVO (1962-2015); The Authors (2016-present)
To analyze the different topographic features of dome-shaped macula including the choroidal thickness and their related complications.
The records of thirty three patients with a dome-shaped macula in one or both eyes (48 eyes) referred for decreased vision were reviewed. Each patient underwent a complete ophthalmologic examination including axial length measurement, spectral domain optical coherence tomography (SD-OCT), and fluorescein and indocyanine green angiography. The most cambered axis of the macula (MCA) was determined and the height of the macular bulge (HMB) relative to the bottom of the staphyloma was measured on SD-OCT. A map of choroidal thickness was created allowing to measure the mean choroidal thickness within the foveal center at 1 mm intervals compared to the choroidal thickness at 3 mm temporal and nasal to the fovea.
Patients’ mean age was 55 (± 13.6) years. The mean axial length was 27.49 (± 2.53) mm, with a mean refractive error of -10.5 (± 5.2) diopters. Mean best-corrected visual acuity (VA) was 0.50 (± 0.33) logMAR. A SRD was present in 25/48 eyes (52.1%). The MCA was vertical in 28 eyes (58.3%) and horizontal in 20 (41.7%). Four topographic dome-shaped macula patterns were observed according to the MCA orientation and importance: the dome orientation was horizontal in 29.2% of cases (14/48), vertical in 16.7% (8/48), centered with no evident predominant axis in 20.8% (10/48) and “racket shaped”, when the macular bulge was extended to the optic disc, in 33.3% of cases (16/48). There was no difference in VA between the 4 patterns. Mean HMB (in the most cambered axis) was 407.7 (± 215.1) µm (range: 120 to 1130). Mean choroidal thickness was 146.5 (± 56) µm within the foveal center, significantly greater than at 3 mm nasal (123.5 ± 59.2; p<.0001) and temporal to the fovea (102 ± 50.5 µm; p<.0001). The HMB was positively correlated with the central choroidal thickness (p=.014) and greater when the dome was vertically oriented (p=.008) but did not correlate with VA. The presence of SRD was significantly increased for HMB > 350 µm (p = .0047) and vertically oriented bulges (i.e with horizontal MCA) (p=.045). SRD was a risk factor of decreased vision (p=.043).
Four patterns of dome-shaped macula were distinguished according to their most cambered axis. The risk of chronic SRD and decreased vision was greater in dome-shaped maculas with high and vertically oriented bulges.
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