title: Choroidal findings in dome-shaped macula in highly myopic eyes: a longitudinal study.
abstract: OBJECTIVE
  To describe choroidal findings in dome-shaped macula associated with high myopia using fluorescein angiography (FA), indocyanine green angiography (ICGA), and spectral-domain optical coherence tomography (SD OCT), and to elucidate the mechanism and natural course of serous retinal detachment (RD) associated with dome-shaped macula.
  
  
  METHODS
  Retrospective, observational case series.
  
  
  METHODS
  We reviewed longitudinal imaging results of 52 highly myopic eyes with dome-shaped macula. Changes on FA and ICGA were assessed. Retinal, choroidal, and scleral thicknesses and bulge height were measured on SD OCT.
  
  
  RESULTS
  Serous RD was the most common abnormality associated with dome-shaped macula, detected by SD OCT in 44% of the cases with no associated choroidal neovascularization. Significant differences in the proportion of eyes with pinpoint leakage on FA (P < .001), punctate hypercyanescence on ICGA (P < .001), and pigment epithelium detachment on SD OCT (P < .001) were noted inside the inward bulge of the staphyloma between eyes with and without serous RD. Serous RD was not associated with hyperpermeability areas on ICGA. Eyes with serous RD had thicker choroid (P = .004) and tended to have thicker sclera (P = .067) and greater bulge height (P = .079). Choroidal thickness, scleral thickness, and bulge height were positively correlated (P < .01). All eyes presented a fluctuating course of serous RD during follow-up. Worsening of serous RD was associated with appearance of new punctate hypercyanescent spots on ICGA and leaking points on FA (P < .001 and P = .016, respectively).
  
  
  CONCLUSIONS
  Serous RD in dome-shaped macula was likely caused by choroidal vascular changes, similar to central serous chorioretinopathy, but specifically confined in the inward bulge of the staphyloma and secondary to excessive scleral thickening. Serous retinal detachment showed fluctuating changes over time, with alternating active and inactive stages. Angiographic findings in dome-shaped macula suggest the choroid as a target for possible treatment strategies.
authors.affiliation: Ophthalmological Unit, Ca' Granda Foundation-Ospedale Maggiore Policlinico, University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy. Electronic address: francesco.viola@unimi.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Viola
authors.affiliation: Ophthalmological Unit, Ca' Granda Foundation-Ospedale Maggiore Policlinico, University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Dell'Arti
authors.affiliation: Ophthalmological Unit, Ca' Granda Foundation-Ospedale Maggiore Policlinico, University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Benatti
authors.affiliation: Ophthalmological Unit, Ca' Granda Foundation-Ospedale Maggiore Policlinico, University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy; Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Invernizzi
authors.affiliation: Ophthalmological Unit, Ca' Granda Foundation-Ospedale Maggiore Policlinico, University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Mapelli
authors.affiliation: Ophthalmological Unit, Ca' Granda Foundation-Ospedale Maggiore Policlinico, University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Ferrari
authors.affiliation: Ophthalmological Unit, Ca' Granda Foundation-Ospedale Maggiore Policlinico, University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Ratiglia
authors.affiliation: Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco," Luigi Sacco Hospital, University of Milan, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Staurenghi
authors.affiliation: Ophthalmological Unit, Ca' Granda Foundation-Ospedale Maggiore Policlinico, University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Barteselli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002829:Choroid / Q000473:pathology; D004396:Coloring Agents; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007208:Indocyanine Green; D008137:Longitudinal Studies; D008266:Macula Lutea / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000175:diagnosis*; D012163:Retinal Detachment / Q000175:diagnosis*; D055213:Retinal Pigment Epithelium / Q000473:pathology; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence / Q000379:methods; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green