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Angelo M. Minnella, Cristina Maria Savastano, Benedetto Falsini, Giacomilde Mazzone, Matteo Federici, Mariangela Gari, Lucilla Barbano, Carmela Grazia Caputo, Emilio Balestrazzi; Neuroretinal Detachment in Dome Shaped Syndrome. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2179.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the possible etiopathogenesis of foveal neuroretinal detachment in dome shaped macula.
In the observational period of 18 months, we recruited five eyes of three patients (Female: Male=2:1) with mean age of 56.4 (SD±2.3) years. Inclusion criteria were: no media opacity, maximum antero-posterior axial length not superior of 26 mm, dome shaped macula with foveal neuroretinal detachment. Exclusion criteria were: vitreoretinal traction detectable of the SD-OCT, macular oedema, ocular tumors, and previous inflammatory diseases. All patients underwent complete ophthalmoscopic examination including best corrected visual acuity (BCVA), fundus biomicroscopy, axial length measurement, spectral domain-optical coherence tomography (SD-OCT) analysis; fluorescein angiography (FA) and indocyanine angiography (ICA) evaluations, B-scan ultrasonography and microperimetry-MP1 assessments.
All eyes received 2 photodynamic therapy (PDT) treatments and 3 anti-Vascular Endothelium Growth Factor (anti-VEGF) injections. No morpho-functional changes were observed throughout the follow-up. At the end of follow-up a mean VA reduction from 24.8 (±4) to 22.2 (±2) ETDRS letters was recorded. Ultrasonography showed scleral curvature changes with pronounced convex appearance only at posterior pole. FA and ICA confirmed the absence of neovascular or other inflammatory diseases. SD-OCT showed the bulge formed of the macula: "dome shaped", with an abnormal adhesion of the photoreceptor outer segments with retinal pigment epithelium. Microperimetry analysis showed a mean sensitivity reduction from baseline (6.84 dB ±1.4) to 18 months (6.4 dB ±1.4).
We observed no response to different therapeutic procedures in eyes with subretinal fluid related to "dome shaped". The reason for this failure remains unclear. However, the SD-OCT results suggest that an abnormal mechanical adhesion of photoreceptors tip with RPE cells, with twist and cell separation, is a major underlying pathologic mechanism of the disease.
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