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PLoS One. 2017 Jun 1;12(6):e0178998. doi: 10.1371/journal.pone.0178998. eCollection 2017.

Macular Bruch's membrane defect and dome-shaped macula in high myopia.

Author information

1
Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan.
2
Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany.

Abstract

PURPOSE:

To examine an association between macular Bruch's membrane defects (MBMD) and a dome-shaped appearance of the macula (DSM).

DESIGN:

Retrospective, observational case series study.

METHODS:

The study included highly myopic individuals who were consecutively examined between May 2014 and December 2015. The patients underwent swept-source optical coherence tomography (OCT) for visualization of DSM and MBMDs defined as Bruch´s membrane defects located at a distance of maximal 1500 μm from the foveola.

RESULTS:

Out of 1983 highly myopic eyes (1057 patients), 166 eyes (8.4%; 95% confidence interval (CI):7.2%,9.6%)) showed a DSM and 534 eyes showed a MBMD. In multivariate binary regression analysis, higher prevalence of DSM was associated with a higher prevalence of a MBMD (P<0.001; OR: 1.96; 95%CI: 1.40, 2.75) after adjusting for longer axial length (P<0.001; odds ratio (OR): 1.27; 95%CI: 1.16, 1.38). In eyes with a DSM partially surrounded by a MBMD, the retina, retinal pigment epithelium (RPE) and choroid appeared relatively unchanged in the central region with Bruch´s membrane (BM) preserved. In the ring-like BM-free region surrounding the central prominent island of the DSM, the RPE, the outer and middle retinal layers, the choriocapillaris and the middle-sized choroidal vessel layer were absent. In association with a DSM, three MBMD types were differentiated: MBMDs in patchy chorioretinal atrophy, MBMDs in choroidal neovascularization-related macular atrophy, and MBMDs as temporally extending large parapapillary gamma zone.

CONCLUSIONS:

Presence of a DSM was significantly associated with the presence of MBMDs. The morphology of the DSM in association with MBMDs may be associated with a focal relaxation of the posterior sclera, no longer pushed outward by an expanding BM but allowed to partially bulge inward, leading to the formation of a DSM.

PMID:
28570624
PMCID:
PMC5453614
DOI:
10.1371/journal.pone.0178998
[Indexed for MEDLINE]
Free PMC Article

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