Dome and Ridge-Shaped Macula Angle and its Association with Subretinal Fluid

Abstract

INTRODUCTION: Dome and ridge-shaped macula (DSM and RSM) are defined by a bulge of retinal pigment epithelium (RPE), choroid, and sclera of more than 50 μm in height above a line connecting the RPE on both sides, in an optical coherence tomography exam (OCT). RSM is defined by a macular elevation only in one meridian across the fovea, whereas the DSM has an elevation in both horizontal and vertical meridians. Their pathogenesis remains controversial. The purpose of this study is to compare OCT parameters in eyes with DSM and RSM with and without subretinal fluid (SRF).
METHODS: A retrospective, single-center study was conducted in Centro Hospitalar Universitário de São João (Porto, Portugal). Data collected included age at diagnosis, the affected eye, type of bulge (DSM or RSM), best corrected visual acuity (BVCA), spherical equivalent, intraocular pressure (IOP), subfoveal choroidal thickness (SCT), DSM and RSM angle, and complications.
RESULTS: Fifty eyes from 27 patients were evaluated. Twenty-three patients were female (85.19%) and the mean patient age was 53.1 years (range 20–90 years). The condition was bilateral in 23 patients (85.19%). Twenty eyes were identified as RSM and 24 eyes as DSM. In the remaining 6 eyes only, horizontal scans were performed. The mean spherical equivalent was not statistically different between the group without SRF and the group with SRF (-11.8±6.7 D vs -7.5±6.4 D, p=0.059). No significant difference was observed in the IOP between both groups (p=0.458). The mean SCT was higher in eyes with SRF (129.44±125.96 μm vs 233.63±99.18 μm, p=0.006). DSM/RSM angle was positively correlated to the SRF area (p=0.026) but no significant correlation was found between SCT and the SRF area (p=0.759). The proportion of eyes with SRF was not different between eyes with DSM and RSM (p =0.601). The following complications were found: SRF (N=16), epiretinal membrane (N=9), macular neovascularization (N=8), retinoschisis (N=4), and macular pseudohole (N=3).
CONCLUSION: Eyes with DSM/RSM complicated with SRF have a greater SCT. DSM/RSM angle may be a useful OCT marker when evaluating patients with DMS/RSM as it seems to be associated with more SRF.