Transient Improvement in Myopic Dome-Shaped Maculopathy after Vitrectomy

Background

Dome-shaped macula (DSM) is defined as a convex protrusion of the macula within a staphyloma at the posterior pole of highly myopic eyes [1]. DSM occurs approximatively in 20 % of highly myopic eye, but it can also rarely be seen in emmetropia [2] or in association with retinal dystrophies such as X-linked retinoschisis, cone dystrophy or congenital stationary night blindness) [3]. Between 50–78 % of patients have bilateral DSM [1], [3], [4]. The cardinal signs are decreased central vision and metamorphopsia, which are caused in order of importance by subretinal fluid, retinal pigment epithelial (RPE) detachment or atrophy [5]. Serous fluid accumulation is likely to be caused by choroidal vascular abnormalities and thickening confined within the staphyloma, particularly on the inside of the inward bulge of the staphyloma, which are secondary to increased subfoveal scleral thickness and associated with bulge height. This may result in localised RPE damage with slow choroidal leakage leading to fluctuating serous fluid accumulation and RPE atrophy [6].

Todate only isolated cases have been described which respond to experimental treatments. Photodynamic therapy has, for example, been shown to eliminate subretinal fluid in some cases of DSM, but both limited therapeutic effects and recurrences have been reported [7]. More recently spironolactone has also been used to decrease subretinal fluid in DSM [8], [9]. In very rare cases DSM may also spontaneously resolve [10].

We report a case of DSM with serous retinal detachment, which was operated on for bilateral vitreal opacities. Apart from curing the myodesopsia, vitrectomy surprisingly induced an important temporary regression of the serous retinal detachment in both eyes.

• References

• 1 Gaucher D, Erginay A, Lecleire-Collet A. et al. Dome-shaped macula in eyes with myopic posterior staphyloma. Am J Ophthalmol 2008; 145: 909-914
• 2 Kedkovid N, Afshar AR, Damato BE. et al. Dome-shaped macula with thickened choroid in an emmetropic patient. Retin Cases Brief Rep 2015; 9: 307-310
• 3 Errera MH, Michaelide M, Keane PA. The extended clinical phenotype of dome-shaped macula. Graefes Arch Clin Exp Ophthalmol 2014; 252: 499-508
• 4 Imamura Y, Iida T, Maruko I. et al. Enhanced depth imaging optical coherence tomography of the sclera in dome-shaped macula. Am J Ophthalmol 2011; 151: 297-302
• 5 Deobhakta A, Ross AH, Helal jr. J. et al. Localized choroidal thickness variation and pigment epithelial detachment in dome-shaped macula with subretinal fluid. Ophthalmic Surg Lasers Imaging Retina 2015; 46: 391-393
• 6 Viola F, DellʼArti L, Benatti E. et al. Choroidal findings in dome-shaped macula in highly myopic eyes: a longitudinal study. Am J Ophthalmol 2015; 159: 44-52
• 7 Chinskey ND, Johnson MW. Treatment of subretinal fluid associated with dome-shaped macula. Ophthalmic Surg Lasers Imaging Retina 2013; 44: 593-595
• 8 Dirani A, Matet A, Beydoun T. et al. Resolution of foveal detachment in dome-shaped macula after treatment by spironolactone: report of two cases and minireview of the literature. Clin Ophthalmol 2014; 20: 999-1002
• 9 Fernández-Vega Sanz Á, Rangel CM, Villota Deleu E. et al. Serous retinal detachment associated with dome-shaped macula and staphyloma edge in myopic patients before and after treatment with spironolactone. J Ophthalmol 2016; 2016: 8491320
• 10 Tamura N, Sakai T, Tsuneoka H. Spontaneous resolution of foveal detachment in dome-shaped macula observed by spectral domain optical coherence tomography. Clin Ophthalmol 2014; 8: 83-86
• 11 Chebil A, Ben Achour B, Chaker N. et al. Chroroidal thickness assessment with SD-OCT in high myopia with dome-shaped macula. J Fr Ophtalmol 2014; 37: 237-241
• 12 Ellabban AA, Tsujikawa A, Matsumoto A. et al. Three-dimensional tomographic features of dome-shaped macula by swept-source optical coherence tomography. Am J Ophthalmol 2013; 155: 320-328
• 13 Simpson AR, Dowell NG, Jackson TL. et al. Measuring the effect of pars plana vitrectomy on vitreous oxygenation using magnetic resonance imaging. Invest Ophthalmol Vis Sci 2013; 54: 2028-2034
• 14 Stefánsson E. Physiology of vitreous surgery. Graefeʼs archive for clinical and experimental ophthalmology 2009; 247: 147-163
• 15 Ahn SJ, Woo SJ, Park KH. Choroidal thickness change following vitrectomy in idiopathic epiretinal membrane and macular hole. Graefes Arch Clin Exp Ophthalmol 2016; 254: 1059-1067
• 16 Negi A, Kawano S, Marmor MF. Effects of intraocular pressure and other factors on subretinal fluid resorption. Invest Ophthalmol Vis Sic 1987; 28: 2099-2102
• 17 Yoon YH, Marmor MF. Effects of retinal adhesion of temperature, cyclic AMP, cytochalasin, and enzymes. Invest Ophthalmol Vis Sci 1988; 29: 910-914