Macular Curvature in Adults Born Preterm With and Without ROP: Results from the Gutenberg Prematurity Eye Study

Purpose

This study investigated the effects of prematurity and retinopathy of prematurity (ROP) as well as the associations of the ocular geometry with macular curvature in adults.

Methods

The Gutenberg Prematurity Eye Study is a retrospective cohort study of preterm and full-term participants aged 18 to 52 years with a prospective ophthalmologic examination. The main outcome measure was the macular curvature in the central foveal optical coherence tomography (OCT) scan and its associations with gestational age (GA), birth weight and birth weight percentile, ROP occurrence, ROP treatment, and other perinatal factors were evaluated in univariable and multivariable linear regression analyses. Furthermore, a second model assessed the association of ocular geometry with macular curvature.

Results

In the present study, 550 eyes of 284 adults born preterm and 277 eyes of 139 adults born full-term were examined (aged = 28.7 ± 8.7 years, 240 female subjects). In multivariable analyses for perinatal parameters, ROP treatment (B = -52.44, P = 0.023) and maternal smoking during pregnancy (B = 26.41, P = 0.019) showed an association with macular curvature. Regarding ocular geometric parameters, posterior segment length (B = 9.07, P < 0.001) and subfoveal choroidal thickness (B = -0.26, P < 0.001) were associated with macular curvature, central corneal thickness, anterior chamber depth, lens thickness, and foveal retinal thickness were not associated.

Conclusions

Adults treated for ROP had relatively more negative curvature values compared to the full-term group, indicating a macular protrusion toward the vitreous cave. A thicker subfoveal choroidal thickness was associated with a flatter macular curvature, whereas a longer posterior segment length was associated with a steeper macular curvature indicating the characteristics of the myopic elongation of the eye.

LONG-TERM EVOLUTION OF MYOPIC RETINOSCHISIS WITH A DOME-SHAPED MACULA AND PREDICTORS OF PROGRESSION AND VISUAL PROGNOSIS

PURPOSE

To study the long-term natural course of myopic retinoschisis (MRS) with a dome-shaped macula (DSM) and to identify the factors affecting its development and visual prognosis.

METHODS

In this retrospective case series study, we followed 25 MRS eyes with a DSM and 68 MRS eyes without a DSM for at least two years and observed changes in optical coherence tomography morphologic features and best-corrected visual acuity.

RESULTS

During the mean follow-up of 48.3 ± 13.24 months, the difference in the rate of MRS progression between the DSM and non-DSM groups was not significant ( P = 0.7462). In the DSM group, the patients whose MRS progressed were older and had a higher refractive error than those whose MRS was stable or improved ( P = 0.0301 and 0.0166, respectively). The patients whose DSM was located in the central fovea had a significantly higher progression rate than those whose DSM was located in the parafovea ( P = 0.0421). For all DSM eyes, BCVA did not decrease significantly in eyes with extrafoveal retinoschisis ( P = 0.2500), patients whose best-corrected visual acuity decreased more than two lines had a greater central foveal thickness initially than those whose best-corrected visual acuity decreased less than two lines during the follow-up period ( P = 0.0478).

CONCLUSION

A DSM did not delay the progression of MRS. The development of MRS in DSM eyes was associated with age, myopic degree, and DSM location. A higher schisis cavity predicted visual deterioration, and a DSM protected visual function in extrafoveal MRS eyes during the follow-up period.

[Micropulse laser treatment of complicated forms of sclerogenic macular degeneration]

Focal dome-shaped prominence of the macular profile due to thickening of the scleral layers leads to the development of sclerogenic macular degeneration (SMD), which causes a decrease in vision when it evolves into complicated forms.

PURPOSE

To evaluate the effectiveness of subthreshold micropulse laser (SML) coagulation in patients with SMD complicated by detachment of neuroepithelium.

MATERIAL AND METHODS

The study included 14 patients (13 women and 1 man), aged 28 to 63 years, median age 55.5 (50; 62) years. All patients underwent standard ophthalmologic examination, optical coherence tomography, as well as fluorescence and/or indocyanine-green angiography. Subthreshold micropulse laser treatment was performed using a diode laser with a wavelength of 810 nm, and consisted of 2-3 sessions of 10% micropulse duty cycle in subthreshold mode with an interval of 2-4 months. Patient data were recorded at 5 time points, each subsequent data point was compared with the baseline. Treatment was carried out according to the dense "lattice" technique with an additional effect on the dye leakage zones. The follow-up period lasted 6-12 months.

RESULTS

Complete regression of subretinal fluid after all SML sessions was observed in 42.9% of cases. In other cases, persistent positive dynamics in terms of edema decrease was noted. The average values of best corrected visual acuity did not significantly change over the course of the follow-up. According to the OCT data, choroidal thickness in fovea significantly decreased at the 1st, 3rd and 4th time points, while the retinal thickness did not significantly change during the observation period.

CONCLUSION

Subthreshold micropulse laser treatment accelerates the resorption of subretinal fluid in SMD, but this effect cannot be considered satisfactory due to the very slow rate of resorption of subretinal fluid and the absence of a significant effect on visual acuity of patients. The effectiveness of this technique must be compared with other treatment techniques and the natural course of the disease.

Dome-Shaped Macula versus Ridge-Shaped Macula Eyes in High Myopia Based on the 12-line Radial Optical Coherence Tomography Scan Pattern. Differences in Clinical Features

PURPOSE

To study clinical features in patients with ridge-shaped macula (RSM) compared with those with dome-shaped macula (DSM) having been previously classified by the number of swept-source optical coherence tomography (SS-OCT) radial scans affected.

METHODS

Retrospective observational study including 49 highly myopic eyes from 31 patients who underwent SS-OCT. DSM eyes were defined as those that showed a complete round inward convexity in all their axes, presenting an inward convexity ≥50 µm in the 12-line radial OCT scans. Eyes that did not meet this criterion and had at least one flat radial scan were grouped into the RSM group, defined as a macular inward convexity in some meridians across the fovea, whereas the opposite perpendicularly oriented meridians were flat. Age, spherical equivalent, axial length (AL), and best-corrected visual acuity (BCVA) were collected. Height of the bulge, scleral and choroidal thicknesses, Bruch´s membrane defects, and presence of perforating scleral vessels were recorded.

RESULTS

Thirty-seven (75.5%) eyes were classified into the RSM group and 12 (24.5%) into the DSM group. Twenty-six (53.0%) eyes showed macular elevation only in the horizontal direction. Mean AL showed statistically significant differences (28.8 ± 2.7 vs. 30.5 ± 1.5 mm in the RMS vs. DSM group, respectively) and the presence of Bruch´s membrane defects was more frequently seen in DSM (p < 0.001). Mean age, spherical equivalent, BCVA, height of the inward convexity, retinal foveal thickness, foveal scleral thickness, subfoveal choroidal thickness, and the presence of perforating scleral vessels did not show significant differences between groups.

CONCLUSION

This study shows the reliability of using the 12 equal radial OCT scans as an objective method to define and differentiate DSM versus RSM. Patients with RSM showed differences in AL compared with those with DSM, being longer in DSM, and regarding the presence of Bruch´s membrane defects, being more common in DSM. This may contribute to identifying those patients that, in daily clinical practice, have a higher risk of developing complications due to their myopia.

Dome-shaped macula-Review of literature

Dome-shaped macula is a convex retinochoroidal elevation within the region of a posterior staphyloma seen commonly in high myopia on optical coherence tomography. With growing awareness of the condition facilitated by inclusion of optical coherence tomography in routine retinal practice, coupled with evolution of enhanced depth optical coherence tomography imaging, multiple studies have attempted to shed light on pathogenesis of this complex pathology, its clinical implications, and treatment of associated complications such as serous macular detachment and choroidal neovascularization with variable success. Our review aims to assimilate, scrutinize, and discuss the available literature for a comprehensive insight into dome-shaped macula.

Dome-shaped macula: a potential protective factor for visual acuity after cataract surgery in patients with high myopia

PURPOSE

To evaluate whether the presence of dome-shaped macula (DSM) is a protective factor for visual acuity after cataract surgery in patients with high myopia.

METHODS

Included were 891 highly myopic cataract eyes (600 patients) that were examined by optical coherence tomography (OCT) through the central fovea and underwent cataract surgery in our hospital. DSM was defined as an inward bulge >50 µm in horizontal or vertical OCT sections. The incidences of various maculopathies were compared between eyes with and those without DSM. The influences of age, sex, eye laterality, axial length and DSM on postoperative visual acuity were evaluated by multivariate linear regression.

RESULTS

Of the 891 eyes, 123 (13.8%) had DSM. There was a greater association of DSM with extrafoveal retinoschisis (RS) than with other vision-threatening complications such as foveal RS and choroidal neovascularisation. In addition to axial length and age, sex was associated with the presence of DSM (p=0.016). In bilateral high myopia, the incidence of DSM increased with the degree of anisometropia and was more common in the longer eye of patients with anisometropia. Younger age, male sex, shorter axial length and the presence of DSM were associated with better postoperative visual acuity in highly myopic cataract eyes (β=0.124, p=0.002; β=0.142, p<0.001; β=0.275, p<0.001 and β=-0.088, p=0.038, respectively).

CONCLUSION

Associated with fewer visual threatening macular complications, presence of DSM may be a protective factor for visual function after cataract surgery in highly myopic eyes.

Observational study of clinical characteristics of dome-shaped macula in Chinese Han with high myopia at Zhongshan Ophthalmic Centre

PURPOSE

To evaluate the prevalence of dome-shaped macula (DSM) in highly myopic eyes among Chinese Han and to detect the correlation with myopic maculopathy and macular complications.

METHODS

A total of 736 Chinese Han patients (1384 eyes) with high myopia (refractive error≤6.0 diopters or axial length ≥26.5 mm) are reviewed based on information entered into a high-myopia database at Zhongshan Ophthalmic Centre. Subfoveal choroidal thickness (SFCT) and parafoveal choroidal thickness (PFCT) are measured. The prevalence of DSM in patients with myopic maculopathy is categorised from C0 to C4. Clinical features, including macular complications, SFCT and PFCT, are compared between myopic eyes with and without DSM.

RESULTS

Among the 1384 eyes, 149 (10.77%) show DSM. In highly myopic eyes without macular complications, the best corrected visual acuity is significantly worse in patients with DSM (p=0.002), and the ratio between subfoveal and parafoveal choroidal thickness (S/PCT) is significantly elevated in patients with DSM (p=0.021). The proportion of foveal schisis (17.24% vs 62.86%) is much lower in eyes with DSM compared with those without DSM. However, the proportions of extrafoveal schisis (39.66% vs 5.37%), foveal serous retinal detachment (SRD) (5.17% vs 0) and epiretinal membrane (ERM) (24.14% vs 10.74%) are much higher in eyes with DSM. The proportion of DSM was lower in C0 and C1, but higher proportion of DSM was found in C3 and C4.

CONCLUSIONS

DSM is found in 10.77% of highly myopic eyes among Chinese Han. DSM might be a protective mechanism for foveal schisis and a risk factor for extrafoveal schisis, SRD and ERM.

[Dome-shaped macula: features of differential diagnostics with clinical examples]

The phenomenon of dome-shaped macula (DSM) constitutes protrusion of membranes of the posterior pole of the eye toward the vitreous body due to local thickening of sclera layers. The phenomenon was detected using enhanced depth imaging optical coherence tomography (EDI-OCT). In uncomplicated forms of DSM, all layers of the retina are contiguous, but the setting of DSM can involve a number of pathological conditions causing decrease in vision. One of the most often described concurrent conditions in DSM is serous retinal detachment (SRD). Such complicated forms of DSM are often masked as a non-pigmented neoplasm of the choroid, in particular hemangioma (HC).

PURPOSE

To demonstrate the possibilities of differential diagnostics of DSM with HC using modern instrumental diagnostic methods.

MATERIAL AND METHODS

The study involved two clinical cases of patients with DSM and HC, who underwent comprehensive ophthalmological examination including EDI-OCT and OCT angiography, fluorescent angiography (FA), indocyanine-green angiography (ICG) and magnetic resonance imaging of brain and orbits (MRI).

RESULTS

The most simple and highly informative method for differential diagnostic of DSM with HC is currently EDI-OCT. In difficult differential diagnostic cases, it is recommended to use FA and MRI. Additionally, for identification of the cause of SRD in DSM, OCT-angiography and ICG-angiography can be used. Thus, diagnostics of DSM is difficult today primarily because of the low awareness of ophthalmologists about the presence of such macula pathology. Detection of this anatomical feature by means of ophthalmoscopy alone can be difficult and requires special skills and experience. The use of EDI-OCT, as well as FA and MRI in difficult differential diagnostic cases, and correct interpretation of the obtained data can help avoid diagnostic errors.

Comparison of the efficacy of intravitreal ranibizumab for choroidal neovascularization due to pathological myopia with and without a dome-shaped macula

Ranibizumab injection in the treatment of choroidal neovascularization (CNV) secondary to pathologic myopia (PM) with and without a dome-shaped macula (DSM).Prospective observational study.A total of 24 patients (24 eyes) with angiographic evidence of CNV secondary to PM were divided into 2 groups: eyes with a DSM and eyes without DSM. All patients received a baseline intravitreal ranibizumab injection. Additional injections were considered at each follow-up visit. Best-corrected visual acuity (BCVA) and optical coherence tomography were tested monthly through 12 months of follow-up. The mean changes in BCVA, central retinal thickness (CRT, including retinal and CNV thickness), and the number of injections were evaluated.There were no significant differences in visual outcomes between the groups over 12 months (P > .05). Patients with a DSM had a mean change in BCVA of +8.7 letters compared with +14.2 letters in patients without a DSM (P = .68). However, there were more patients without a DSM who gained at least 15 letters from baseline compared with patients with a DSM. By the end of the follow-up, there was no significant difference in the mean change in baseline CRT between patients with and without a DSM (-65.0 and -90.7, respectively, P = .42). The mean number of injections was 8.83 in the patients with DSM and 8.17 in the patients without a DSM (P > .05).For the pathological myopia patients who had CNV with a DSM, the DSM did not alter the effect of the ranibizumab treatment. There was no difference in the visual improvement, anatomic benefit and number of treatments between the 2 groups.

Dome-shaped macula simulating choroidal hemangioma in a myopic patient

To describe a case of dome-shaped macula simulating a choroidal hemangioma and discuss multimodal imaging features to distinguish between these disorders. A 52-year-old myopic male with a refraction of -8.00 D in both eyes developed blurred vision in the left eye OS) over 4 years. Fundus examination of the right eye (OD) was unremarkable. In OS, there was a subtle orange-colored mass in the macular region with subretinal fluid, suggestive of choroidal hemangioma. Upon referral, our examination disclosed an echodense mass on ultrasonography of OS, measuring 1.0 mm thickness, and additional staphyloma was noted. Enhanced depth imaging optical coherence tomography (EDI-OCT) confirmed subfoveal fluid over a dome-shaped mass that originated in the sclera and not the choroid, consistent with the dome-shaped macula. The OD showed similar features, but to a lesser degree. Both eyes demonstrated choroidal thinning on EDI-OCT, related to high myopia. Dome-shaped macula can masquerade as choroidal hemangioma, especially when associated with subretinal fluid. In these cases, EDI-OCT can document "tumor" origin from within the sclera and not the choroid.

Resolution of foveal detachment in dome-shaped macula after treatment by spironolactone: report of two cases and mini-review of the literature

Dome-shaped macula (DSM) was recently described in myopic patients as a convex protrusion of the macula within a posterior pole staphyloma. The pathogenesis of DSM and the development of associated serous foveal detachment (SFD) remain unclear. The obstruction of choroidal outflow and compressive changes of choroidal capillaries have been proposed as causative factors. In this paper, we report two cases of patients with chronic SFD associated with DSM treated with oral spironolactone. After treatment, there was a complete resolution of SFD in both patients. To the best of our knowledge, this is the first report of successful treatment of SFD in DSM by a mineralocorticoid receptor antagonist.

Spontaneous resolution of foveal detachment in dome-shaped macula observed by spectral domain optical coherence tomography

Dome-shaped macula (DSM) was described by Gaucher et al as a convex protrusion of macula within a staphyloma in highly myopic eyes that causes visual impairment associated with serous foveal detachment (SFD). We describe a patient with spontaneous resolution of SFD in DSM documented by serial spectral domain optical coherence tomography (SD-OCT). A 28-year-old female Japanese patient presented with blurred vision in both eyes. Upon examination, her best-corrected visual acuity was 1.2 with −8.0 sphere and 0.5 with −8.0 sphere in the right and left eyes, respectively. SD-OCT in both eyes showed an anterior bulge of the macula with SFD. The diagnosis of DSM with SFD was made on the basis of characteristic findings. Three months later, the patient achieved spontaneous resolution of SFD without treatment. One month later, there was an occurrence of SFD in the right eye, but the SFD had disappeared in 1 month. In our case, her visual impairment was proven to be a consequence of SFD in relation to DSM. SD-OCT was useful for the detection and follow-up of SFD in DSM.