Dome-Shaped Macula

Published on 10/05/2015 by admin

Filed under Opthalmology

Last modified 22/04/2025

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Dome-Shaped Macula

Introduction:

Dome-shaped macula is a rare recently identified finding in some highly myopic eyes. It is unclear why certain eyes are affected, but it seems to be due to localized variations in scleral thickness.

Clinical Features:

There is an inward protuberance of the central macula within the larger concave shape of a posterior staphyloma in highly myopic eyes. This condition is not appreciated clinically and was only discovered with the advent of OCT.

OCT Features:

A vertical line scan is more helpful than a horizontal scan in diagnosing dome-shaped macula. Within the convexity of a posterior staphyloma, there is an inward bowing of the sclera within the central macula (Fig. 9.4.1). The overlying macula follows the same contour as the sclera and there is often a cap of subretinal fluid (hyporeflective space), in the absence of any CNV or CSCR. The choroid is typically thin and the underlying sclera can usually be imaged well with standard spectral domain OCT protocols. However, both enhanced depth and swept source imaging techniques offer the ability to visualize deeper structures and are a better choice for assisting in this diagnosis, if available.

Figure 9.4.1 Vertical OCT line scan in dome-shaped macula shows characteristic inward protuberance of the sclera under the central macula (arrowheads). There is also a cap of hyporeflective subretinal fluid, which is present in the absence of choroidal neovascularization.

Ancillary Testing:

Fluorescein can be helpful to rule out the presence of a concomitant CNV or CSCR.

Treatment:

There is no treatment indicated. It is particularly important that, when present, the apparent cap of subretinal fluid is not anti-VEGF or photodynamic therapy responsive. It should not be considered as proof of the presence of a CNV. A brief anti-VEGF therapeutic trial can be considered, but is unlikely to be of benefit.

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Handbook of Retinal OCT Optical Coherence Tomography