Abstract
Purpose: :
To correlate the anatomical and morphologic features of the posterior globe with the pathophysiology in eyes with dome-shaped macula (DSM).
Methods: :
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.
Results: :
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.
Conclusions: :
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.
Keywords: myopia • imaging/image analysis: clinical