Macular Choroidal Thickness in Myopic Eyes with and without a Dome-Shaped Macula: A Case-Control Study

Abstract

Background and Objective: Dome-shaped macula (DSM) has recently been described with myopic staphyloma, which may cause decreased vision. The purpose of this study was to evaluate the choroidal thickness of eyes with and eyes without DSM. Methods: A total of 26 eyes with DSM were paired based on axial length with 26 eyes without DSM. All patients underwent spectral-domain OCT examination using the 7-line EDI (enhanced depth imaging) protocol. The mean choroidal thickness was measured using Early Treatment Diabetic Retinopathy Study (ETDRS) grid areas. Results: Both nasal choroidal thickness and temporal choroidal thickness were significantly thinner in the DSM group (120.43 vs. 159.46 µm, p = 0.035, and 142.17 vs. 187.23 µm, p = 0.021, respectively). However, the mean central choroidal thickness did not differ (152.61 vs. 175.96 µm, p = 0.20). The ratio between central and peripheral choroidal thickness was very significantly elevated with DSM (1.18 ± 0.12 vs. 0.99 ± 0.09, p < 0.0001). Conclusion: Choroidal thickness decreases at the periphery but not in the macular area with DSM. DSM seems not to be due to an inward protrusion of the globe but due to macular anatomical preservation in a growing staphyloma.

Correlation Between Posterior Staphyloma and Dome-Shaped Macula in High Myopic Eyes

“…In another study, they detected decreased choroidal thickness at the periphery but not in the macular area with DSM. 4 Thus, they proposed that DSM might be caused by scleral introversion in resisting the development of staphyloma. 4 Furthermore, Byeon et al suggested that DSM might be associated with posterior staphyloma (PS) (condition which includes extensive protruding of posterior pole plus macular protrusion, extensive protruding of posterior pole plus peripapillary protrusion, and extensive protruding of posterior pole plus inferior staphyloma) or heteromorphosis of the inferior staphyloma.…”

“… 4 Thus, they proposed that DSM might be caused by scleral introversion in resisting the development of staphyloma. 4 Furthermore, Byeon et al suggested that DSM might be associated with posterior staphyloma (PS) (condition which includes extensive protruding of posterior pole plus macular protrusion, extensive protruding of posterior pole plus peripapillary protrusion, and extensive protruding of posterior pole plus inferior staphyloma) or heteromorphosis of the inferior staphyloma. Assuming that the sclera is the thinnest at its peak protrusion area, the macular scleral thickening symptom occurring with complicated staphyloma is a reasonable hypothesis.…”

Dome-shaped macula in children and adolescents

“…However, scleral thickening may not be the only physiopathologic mechanism leading to DSM. In the study of Soudier et al [19], choroidal thickness decreases at the periphery but not in the macular area with DSM, suggesting preserved central macular anatomy. Based on this result, Soudier et al suggested that development of DSM may be due to macular anatomical preservation in a growing staphyloma [19].…”

“…In the study of Soudier et al [19], choroidal thickness decreases at the periphery but not in the macular area with DSM, suggesting preserved central macular anatomy. Based on this result, Soudier et al suggested that development of DSM may be due to macular anatomical preservation in a growing staphyloma [19]. Soudier et al also showed increase in height of the bulge with time, resulting from perimacular extension of the myopic staphyloma [20].…”

Comparison of long-term clinical evolution in highly myopic eyes with vertical oval-shaped dome with or without untreated serous retinal detachment

“…On two-dimensional images, the macular convexity is better seen in horizontal cross-sectional optical coherence tomography (OCT) scans 1–4. Although the pathogenesis of this unusual tomographic feature remains unclear, possible causes have been suggested in the medical literature, including collapse of the scleral wall attributable to insufficient pressure to keep the ectatic distended,5 tangential vitreoretinal traction,5 resistance to staphylomatous deformation,6 defects on the macular Bruch’s membrane,7 sectional thickness of the sclera within a posterior staphyloma8 9 or the results of a compound staphyloma 10 11…”