Title

ANTI-VEGF AND DOME SHAPED MACULA: A CASE REPORT.

Introduction

The DSM was first described by Gaucher in 2008, with a prevalence of 10% in patients with high myopia. Some disease can be associated with DSM as REP alterations, macular holes and foveoschisis. SRF without choroidal neovascularization is commom and usually followed by low visual acuity, however, 31% of SRF are solved without treatment. The pathogenesis remains uncertain, nevertheless some theories are accepted. Gaucher suggest that choroidal abnormalities and thickening located in DSM are mechanical and vascular damage combined by excessive scleral thickening within staphyloma. In the flurescein angiography, appears as pinpoint leakage in the late phase associated with atrophics alterations of RPE, resembling central serous chorioretinopathy.

Methods

Medical Records Reviews

Results

A 52-year-old female patient, with high myopia complaining of low visual acuity in both eyes (BE) in the past 6 months, presenting VA of 20/64 (BCVA). The initial fundoscopy revealed myopic fundus without other abnormalities. The Optical Choerence tomography (OCT) presented DSM with SRF in BE. The patient was in use of spironolatone (75mg per day) for dermatologic reason in the last 5 years. Therefore, injection of Anti-VEGF was performed in rigth eye. After 01 month of the injection, the OCT showed improvement of the SRF in BE, with BCVA of 20/25, that remains for the next 6 months.

Discussion

Although some cases are solved without intervention, some treatments have ben proposed, such as spironolactone, half-fluence photodynamic therapy and focal laser. Recent reviews suggests that intravitreal injection of ANTI VEGF does not improve the SRF of DSM, while others assert benefits. DSM is a prevalent alteration in eyes with high myopia and SRF is an important reason of Low VA. As treatment for the SRF, the conservative methods are expectant or the use of spironolactone. In our case report, Anti-VEGF injection was performed in one eye (right) with improvement of the SRF in BE, suggesting a systemic effect of the drug.

Keywords

Dome shaped macula Subrretinal fluid Anti-VEGF

Area

CLINICAL CASE

Authors

Gabriel Castilho Sandoval Barbosa, Luciano Rabello Netto Cirillo, Priscilla Alves Nascimento, Allan Gomes da Silva, Cristina Nery Carbajo, Pedro Arthur Hamamoto Marcelino, Julio Zaki Abucham Neto, Vagner Loduca Lima