Serous Macular Detachment Associated with Dome-Shaped Macula and Tilted Disc

Abstract

Introduction: An entirely new type of staphyloma has been recently described as dome-shaped macula (DSM). It is characterized by an abnormal convex macular contour within the concavity of a posterior staphyloma. We found DSM associated with serous macular detachment (SMD) and tilted disc in two consecutive cases. Case Reports: Case 1: A 37-year-old female presented to our department because of sudden onset blurred vision in her right eye (OD). The best-corrected visual acuity (BCVA) was 0.5 in both eyes. Funduscopy evidenced bilateral tilted disc associated with posterior staphyloma. Optical coherence tomography (OCT) demonstrated a DSM with SMD in her OD. After 15 months of follow-up, BCVA of her OD remained stable with chronic SMD. Case 2: A 32-year-old female presented to our department because of blurred vision in her OD. The BCVA was 0.4 in the OD and 1.0 in the left eye (OS). Bilateral tilted disc and posterior staphyloma were evidenced in the funduscopy. OCT demonstrated a bilateral DSM with SMD in her OD. After 45 months of follow-up, two further episodes of transient SMD were observed in her OD and seven in her OS. The final BCVA was 0.63 in the OD and 0.8 in the OS. Discussion: SMD associated with tilted disc constitutes a potential cause of subretinal fluid accumulation in myopic patients. OCT is essential for the detection of both SMD and DSM.

Dome shaped maculopathy with tilted disc misdiagnosed as central serous chorioretinopathy

“…Hence, presence of any atypical sign should arouse the suspicion of an alternative pathology, in our case the TD. In cases of TD, there is partly normal and partly abnormal curvature of posterior sclera 1 2. DSM is considered by most to be a scleral anomaly and as seen in our case, has been rarely reported with TD in absence of a staphyloma 1.…”

“…In cases of TD, there is partly normal and partly abnormal curvature of posterior sclera 1 2. DSM is considered by most to be a scleral anomaly and as seen in our case, has been rarely reported with TD in absence of a staphyloma 1. As opposed to thin sclera of myopic DSM, other types of DSM show a thickened sclera that impairs fluid outflow and vascular supply, subsequently impairing the RPE and choroidal function and leading to findings like pigment epithelium detachment and SRF 2.…”

“…The treatment options of photodynamic therapy, laser photocoagulation and anti-vascular endothelial growth factor therapy have only a limited success and should be considered only in cases of persistent or quickly recurrent SRF and deterioration of vision 1. As spontaneous resolution of SRF in DSM has also been seen and stability of vision is known in cases with persistent SRF, we observed the patient.…”

Analyses of shape of eyes and structure of optic nerves in eyes with tilted disc syndrome by swept-source optical coherence tomography and three-dimensional magnetic resonance imaging

“…A PubMed search using keywords 'tilted disc' and 'optical coherence tomography (OCT)' on 2 October 2012 extracted 13 articles. However, after excluding the myopic disc tilt, only seven studies examined TDS by OCT. [8][9][10][11][12][13][14] The purpose of OCT examination in six of these studies was limited to measuring the thickness of the peripapillary retinal nerve fiber layer or to analyzing the macular pathologies, for example, serous retinal detachment and choroidal neovascularization. It was not possible to observe the deeper structures within the optic nerve or the deeper tissues of the eye by conventional OCT.…”

Serous Retinal Detachment Associated with Dome-Shaped Macula and Staphyloma Edge in Myopic Patients before and after Treatment with Spironolactone

“…Currently there is no adequate treatment for SRD associated with a dome-shaped macula or staphyloma edge. There have been several approaches, ranging from observation [ 6 ] in which spontaneous resolution occurred in some cases [ 7 ] to other treatments such as argon laser photocoagulation [ 1 ], photodynamic therapy [ 8 ], and intravitreal antiangiogenic therapy with inhibitors of vascular endothelial growth factor [ 9 ]. The results have been highly variable.…”