Multimodal imaging in dome shaped macula with mixed type choroidal neovascularisation

Author: Rim Bouraoui (Tunisia)

Co-authors: Khaled El Matri, Maroua Masmoudi, Asma Hassairi, Iness Hachicha, Fatma Mghaieth, Leila El Matri

Purpose

To describe a case of dome-shaped macula (DSM) with mixed type choroidal neovascularisation in multimodal imaging including indocyanine green angiography, swept-source optical coherence tomography (SS OCT) and optical coherence tomography angiography (OCT-A).

Setting/Venue

Hédi Rais Institute of ophthalmology, Department B, Tunis, Tunisia

Methods

case report

Results

A 51 year-old female presented with complaints of recent decrease of vision of the right eye and metamorphopsia for the past 10 days. Her best corrected visual acuity was1/10 in the right eye and 10/10 in the left eye. She has moderate myopia (2.25 D). Biomicroscopic examination of the anterior segment of eyes was unremarkable, fundus examination revealed macular hemorrhage, retinal pigment epithelium alterations and gravitational atrophy. Swept source OCT showed vertically oriented oval-shaped dome associated with serous retinal detachement, subretinal hyperreflectivity corresponding to type 2 CNV and a flat-irregular pigment epithelial detachment corresponding to type 1 CNV, subfoveal choroidal thickness was 384 μm and 363 μm, in the right and left eyes, respectively. OCT-A illustrates an abnormal neovascular network in the choriocapillaris and in the outer retina and confirms the presence of a CNV at the level of the flat–irregular pigment epithelial detachment.

Conlusions

Dome-shaped macula was described by Gaucher et al in eyes of myopic patients as an inward protrusion of the macula observed on optical coherence tomography (OCT), this condition can also be found in mildly myopic or even non myopic eyes. Dome-shaped macula may also share some similarities with central serous chorioretinopathy (CSC) and pachychoroid diseases. CNV occurs in 0% to 25% of the cases. Eyes with dome-shaped macula may either develop typical myopic CNV (type 2 CNV) or pachychoroid-associated CNV (type 1 CNV), similar to those observed in central serous chorioretinopathy. Our patient develop the 2 types as well illustrated by multimodal imaging.

Financial Disclosure

None