Posters

Extramacular dome-shaped elevation: A novel finding in a case of high myopia

Poster Details

First Author: V.Mutha INDIA

Co Author(s):                                 

Abstract Details



Purpose:

Dome-shaped macula (DSM) has been described in high myopic eyes with a posterior staphyloma. Herein we describe a similar but extramacular elevation with an overlying large retinal hole in a case of high myopia

Setting:

Case Report Venue: Dr. RP Centre for ophthalmic sciences, AIIMS, New Delhi

Methods:

A 23 year old female patient with high myopia in both eyes and diminution of vision in the left eye even after appropriate refractive correction was seen in our retina clinic as a part of pre refractive surgery screening. Patient gave a history of some retinal laser procedure elsewhere, the details of which were not known. Evaluation included a thorough history, vision assessment using Snellen chart, fundus assessment using indirect ophthalmoscopy, axial length measurement with noncontact partial coherence laser interferometry (IOL Master®; Carl Zeiss Meditec, Jena, Germany), Swept Source optical coherence tomography (SS-OCT) (DRI OCT – Triton; Topcon, Tokyo, Japan): Radial scans via the macula and via the retinal hole were performed and fluorescein angiography (FA) and indocyanine green angiography (ICGA) on Spectralis HRA (Heidelberg Engineering, Heidelberg, Germany). Alongside clinical pictures of the fundus were taken for documentation on Optomap® P200 Ultra-widefield imaging (Optos PLC, Dunfermline, Scotland)

Results:

IOL Master revealed an axial length of 26.62 mm OD and 32.85 mm OS. Best corrected Snellen visual acuity was 20/20 OD and 20/200 OS with a refractive correction of – 6.75 D sphere OD and -17.50 D sphere OS. On indirect ophthalmoscopy of the left eye, we found a tessellated fundus with tilted disc, Curtin’s type 1 posterior staphyloma, myelinated nerve fibres along the superotemporal arcade, a large retinal hole of about 4 disc diameters above the superior arcade, a dull foveal reflex and a Weiss ring suggestive of posterior vitreous detachment. Fundus examination per se was normal in the right eye. SSOCT examination of the left eye via the fovea showed a dome shaped macula with apparent thickening and inward bulge of sclera, altered foveal contour and thickening of retina with cystoid changes (central foveal thickness = 539 microns) while foveal thickness and contour was normal in the right eye (central foveal thickness = 211 microns); Scans passing via the retinal hole showed a minimum hole diameter of 3341 microns and an underlying dome-shaped elevation with a choroidal thickness of 114 microns. FFA and ICGA examination revealed window defect in the area of retinal hole

Conclusions:

We describe a case of extramacular dome-shaped elevation (EDE) with a large overlying retinal hole in a highly myopic young female patient along with a classical DSM. The EDE seen in our case is identical to DSM as described in literature, except that it was extramacular in location. A DSM is associated with an inward bulge of sclera and choroid, thickened choroid, posterior staphyloma usually Curtin’s type I, associated RPE atrophy and to a lesser extent a lamellar or full thickness macular hole. All these were present in our case in an extramacular location. In addition DSM is also associated with serous detachment of macula in about 44%-66% cases which was not seen in our case. Window defect on FFA and ICGA was due to a full thickness retinal hole and associated RPE atrophy but there was no late leakage as described with DSM. EDE may be considered as a new addition to the vast spectrum of fundus findings in high myopia

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