Sir,

A dome-shaped macula (DSM) is an inward protrusion of the macula seen on optical coherence tomography (OCT) in highly myopic eyes, which was first described in 2008 by Gaucher et al.1 Since DSM appears to be a distinct feature of highly myopic eyes,2, 3 it could be suspected that choroidal neovascularization (CNV) that develops in myopic eyes with DSM may have different clinical features and may follow a course different from that of CNV found in myopic eyes without DSM. However, studies on the therapeutic outcome of CNV associated with DSM are limited. When searching PubMed using the keyword ‘dome-shaped macula’, only one brief report that showed the visual outcome of myopic CNV with DSM after 1-year intravitreal ranibizumab treatment was identified.3 The purpose of this study was to determine the 2-year visual and anatomical outcomes of intravitreal bevacizumab (IVB) treatment for myopic CNV with DSM features. The secondary objective was to compare patients with and without DSM, to investigate whether there was any difference in the clinical features and therapeutic outcome in these two groups after IVB treatment.

We retrospectively reviewed the medical records of 50 patients with myopic CNV who received IVB injections between 1 January 2009 and 30 April 2014. Inclusion criteria were as follows: (1) a refractive error ≤−6.0 D or an axial length ≥26.5 mm, (2) the presence of subfoveal, juxtafoveal, or extrafoveal CNV, (3) treatment-naive patients who were treated with at least one IVB, and (4) follow-up of 2 years or more after intravitreal injection. The study was approved by the institutional review board of Yonsei University College of Medicine. After the initial IVB at baseline, retreatments were applied pro re nata on the basis of changes in OCT findings and/or changes in visual acuity. Statistical analysis was performed using SPSS version 20.0 (IBM, Chicago, IL, USA).

Out of 50 eyes with myopic CNV, 9 (18%) eyes showed DSM features. The demographics and clinical characteristics of patients with and without DSM are summarized in Table 1. The eyes with myopic CNV associated with DSM received 4.00±3.04 injections during 2 years, and the recurrence rate over the 2-year period was 33.3%. The mean logMAR best-corrected visual acuity in eyes with DSM significantly improved from 1.20 at baseline to 0.80 at 6 months, 0.76 at 1 year, and 0.72 at 2 years (P=0.048, 0.034, 0.011, respectively). Both retinal and choroidal thickness decreased gradually over 2 years. There was no significant difference between the DSM and the non-DSM group in terms of baseline characteristics and therapeutic outcomes, including number of injections and CNV recurrence. Visual outcomes were also comparable between the two groups at 6 months, 1 year, and 2 years (Figure 1).

Table 1 Demographics and clinical characteristics of patients with and without dome-shaped macula
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Figure 1
figure 1

Visual outcome during the follow-up period after intravitreal bevacizumab treatment in patients with and without a dome-shaped macula. There was no difference between the 2 groups at 6 months, 1 year, and 2 years.

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In conclusion, DSM features were present in 18% of myopic CNV patients, and after a 2-year treatment with IVB, myopic CNV patients both with and without DSM showed equally significant visual benefits and anatomical improvements. The development of CNV in patients with DSM may not be associated with DSM features, but with other more significant factors, such as myopia itself.