Three-dimensional tomographic features of dome-shaped macula by swept-source optical coherence tomography.

PURPOSE To study the tomographic and pathomorphologic features of dome-shaped maculas with swept-source optical coherence tomography (OCT). DESIGN Prospective, cross-sectional study. METHODS The macular area of 51 highly myopic eyes (35 patients) with dome-shaped maculas was studied with swept-source OCT at 1050 nm. Three-dimensional (3-D) data sets were obtained with raster scanning covering a 12 × 8-mm(2) area; 3-D images of the posterior pole were constructed by autosegmentation of the retinal pigment epithelium (RPE). RESULTS In all reconstructed 3-D images of the RPE, 2 outward concavities were seen within the posterior staphyloma and a horizontal ridge was formed between these 2 concavities. In 42 of these eyes, this horizontal ridge was band shaped. The vertical OCT section through the fovea showed a convex configuration of RPE, but the horizontal section showed an almost flat RPE line. In 9 eyes, 3-D images showed a typical dome-shaped convexity within the staphyloma. OCT scans showed no outward protrusions in the external scleral surface, but marked scleral thinning was seen consistent with the 2 outward concavities of the RPE. The sclera of the fovea (518.6 ± 97.6 μm) was significantly thicker than that in all 4 quadrants of the parafoveal area (range, 277.2 to 360.3 μm; P < .001). CONCLUSIONS In highly myopic eyes with a dome-shaped macula, a horizontal ridge is formed within the posterior staphyloma by uneven thinning of the sclera.