Título

CHOROIDAL NEOVASCULARISATION ASSOCIATEDWITH DOME-SHAPED MACULA: A MULTIMODAL ANALYSIS.

Objetivo

To describe the clinical spectrum of choroidal neovascularisation (CNV) complicating dome shaped macula (DSM) by means of multimodal imaging.

Relato do Caso

52-year-old,female, presented with progressive visual loss of the right eye in the last 3 months. On ophthalmologic examination showed best correted visual acuity of 20/200 in the right eye (OD) and 20/70 in the left eye (OS). Anterior biomicroscopy was unremarkable and intraocular pressure was normal in both eyes (OU). FundoscopY revealed rarefaction of the pigment epithelium in OU. The multicolour image illustrated irregular macular reflectance. Opthical coerence tomography showed the presence of dome-shaped macula associated with serous macular detachment (SMD), flat–irregular pigment epithelial detachment and pigment epithelial detachment (PED). Fundus auto fluorescence confirmed the presence of retinal pigment epithelium irregularities at the macula. Fluorescein angiography showed macular hyperfluorescent pinpoints. OCT angiography (OCTA) disclosed the presence of a CNV at the level of the flat–irregular pigment epithelial detachment and PED.

Conclusão

Eyes with dome -shaped macula may develop a peculiar group of complications, including retinal pigment epithelium abnormalities, serous macular detachment and CNV. Cases with SMD and subretinal fibrin deposition can be confused with a CNV. In addition, DSM can be associated with either myopic CNV or pachychoroid-associated CNV. Ten to 18 percent of eyes with DSM are reported to have CNV. Development of CNV in DSM seems not to be because of DSM rather due to myopia itself; however, role of rupture in Bruch membrane in the peri-dome are a cannot be ruled out. Usefulness of anti-VEGF therapy in tackling CNV associated subretinal fluid in such cases is well documented in literature. In eyes with suspicion of CNV, clinical examination and multimodal imaging analysis, especially OCTA is essential for differentiating it from other closely resembling pathologies, as well as diagnosing associated complications.