Abstract
Purpose:
The dome shaped macula (DSM) is a clinical entity recently described in association with a myopic staphyloma, that may cause a decreased vision. The purpose of this study was to study the long term functional and morphological changes in eyes with the dome shaped macula.
Methods:
20 patients and 31 eyes with dome shaped macula were included in this retrospective observational study. The mean follow up was 38,8 months, the mean age of the patients was 53,8 years. The mean refractive error was -8 diopters. Initial ophthalmologic examination included axial length (AL) measurement, fundus photography, angiography and optical coherence tomography (OCT) examinations. Visual acuity (VA) and OCT measurements were repeated at least 6 months after the initial visit. The central retinal thickness (CRT), the choroidal thickness, the presence and height of serous retinal detachment (SRD), the height of macular bulge and the presence of macular anomalies were studied during the follow up.
Results:
VA remained stable during the follow up (p>0,05) but the CRT deacreased significantly (231µ vs 205µ; p=0,03). This decrease did not correlate neither with the AL nor with the presence/importance of SRD. SRD disappeared in 43% of the eyes during the follow up. The height of macular bulge increased significantly (339 vs 362,7; p=0,007). The mean area of pigmented epithelium alterations correlated significantly to the initial height of macular bulge but remyained stable during the follow up. Other macular anomalies were reported or appeared (68% of eyes) during the follow up: macular pucker, pseudo drusen, choroidal neovascularisation, retrofoveolar pigment clumping. Vertical DSM seemed to be at greater risk for macular changes (100% vs 47% in other types of DSM; p=0,053). Focal laser, verteporphin dynamic phototherapy, antiVEGF or corticostéroid intravitreal injections, anti-aldosterone treatments were inefficient in reducing SRD or restoring VA.
Conclusions:
In DSM, the height of the macular bulge seems to increase over time whereas CRT deacreses. Vision can be stable a few years. Treatments for “macular edema” were inefficient in DSM with SRD.
Keywords: 605 myopia •
700 retinal neovascularization •
701 retinal pigment epithelium