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Klin Monbl Augenheilkd 2017; 234(04): 505-507
DOI: 10.1055/s-0042-122467
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Georg Thieme Verlag KG Stuttgart · New York

Transient Improvement in Myopic Dome-Shaped Maculopathy after Vitrectomy

Transiente Reduktion der myopen domförmigen Makula nach Vitrektomie
V. Kheir
1   Jules Gonin Eye Hospital, University of Lausanne, Switzerland (Medical director a. i. Prof. Thomas J. Wolfensberger)
,
C. Chobaz Bürki
2   Private Practice: Place du Marché 6, 2300 La Chaux-de-Fonds, Switzerland
,
T. J. Wolfensberger
1   Jules Gonin Eye Hospital, University of Lausanne, Switzerland (Medical director a. i. Prof. Thomas J. Wolfensberger)
› Author Affiliations
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Publication History

Publication Date:
13 February 2017 (online)

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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.

 

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