Dome-shaped macula with extremely extensive macular edema

Introduction
Dome-shaped macula is characterized by a convex anterior protrusion of the macula towards the vitrous cavity, associated with high myopia and a posterior staphyloma. The etiology is not fully understood.

Case report
We report a case of a 29-year-old woman, with myopia and astigmatism presented to our department complaining of painless deterioration of vision and metamorphopsia in both eyes. The anterior segment and vitreous were unremarkable, fundoscopy showed central chorioretinal atrophy and retinal pigment epithelial changes in OU. Optical coherence tomography scans showed excessive macular edema and numerous hyporeflective sub- and intraretinal spaces in both eyes. Fundus fluorescein angiography revealed numerous punctate areas of contrast leakage at the upper-temporal vascular arch in right eye and a focus of contrast leakage at the superior-temporal vascular arch in left eye. Indocyanine green angio- graphy presented areas with a visible intensified vascular pattern in the posterior pole of both eyes, slightly enhancing in the intermediate phase and extinguishing in the late phase. The diagnosis of dome-shaped macula was established. After anti- inflammatory and diuretic treatment, there was no improvement in visual acuity and morphological changes. The clinical picture remains stable after 1.5 year follow-up.

Conclusions
Dome-shaped macula is still not a fully understood condition. Inconclusive clinical picture may simulate other ocular pathologies. The visual acuity and macular changes seem to be stable over the years even without treatment.