Enhanced Depth Imaging Optical Coherence Tomography of the Sclera in Dome-Shaped Macula

PURPOSE: To examine the posterior anatomic structure of eyes with dome-shaped macula using enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT). DESIGN: Retrospective observational case series. METHODS: Patients with dome-shaped macula, a condition defined as convex elevation of the macula as compared with the surrounding staphylomatous region in a highly myopic eye, were identified through routine examinations using optical coherence tomography (OCT). EDT-OCT was used to examine their posterior anatomic changes. The scleral thickness was measured from the outer border of the choroid to the outer scleral border under the fovea and 3000 pm temporal to the fovea. RESULTS: The mean age of the 15 patients (23 eyes) was 59.3 (+/- 12.2) years, and the mean refractive error was -13.6 (+/- 5.0) diopters. The best-corrected visual acuity ranged from 20/15 to 20/800 (median: 20/30). Eight patients (53%) had dome-shaped macula bilaterally. The mean subfoveal scleral thickness in 23 eyes with dome-shaped macula was 570 (+/- 221) mu m, and that in 25 eyes of 15 myopic patients with staphyloma but without dome-shaped macula was 281 (+/- 85) mu m (P <.001) even though both groups had similar myopic refractive error. The scleral thickness 3000 p.m temporal to the fovea was not different in the 2 groups. CONCLUSIONS: Dome-shaped macula is the result of a relative localized thickness variation of the sclera under the macula in highly myopic patients, and it cannot be categorized into any of the known types of staphyloma. This finding suggests the ocular expansion in myopia may be more complex than previously thought. (Am J Ophthalmol 2011;151:297-302. (C) 2011 by Elsevier Inc. All rights reserved.)