Evaluating the microcirculation of the dome-shaped macula and its complications in adults with highly myopic eyes by swept-source optical coherence tomography angiography

Purpose: The aim of this study was to investigate the microcirculatory characteristics of the dome-shaped macula (DSM), its complications in highly myopic eyes and to explore the factors associated with a DSM. Methods: This cross-sectional case-control study included a total of 98 subjects (98 eyes): 49 eyes with DSM and 49 eyes without DSM. The axial length (AL) of the myopic eyes was matched 1:1 to eliminate the effect of AL differences on the results. Choroidal (CT) and scleral thickness (ST) and other structural parameters were assessed by swept-source optical coherence tomography (SS-OCT). OCT angiography was used to measure microcirculatory parameters in highly myopic eyes. Results: Subjects with DSM had thinner subfoveal choroidal thickness (46.01 +/- 13.25 vs. 81.62 +/- 48.26 mu m; p < 0.001), thicker subfoveal scleral thickness (SFST; 331.93 +/- 79.87 vs. 238.74 +/- 70.96 mu m; p < 0.001) and thinner foveal CT (66.86 +/- 24.65 vs. 107.85 +/- 52.65 mu m; p < 0.001) compared to subjects without DSM. The foveal choroidal perfusion area (0.72 +/- 0.04 vs. 0.76 +/- 0.04 mm(2); p < 0.001) and foveal choroidal vascularity index (0.15 +/- 0.04 vs. 0.33 +/- 0.14; p < 0.001) were significantly lower in eyes with DSM. Retinoschisis (81.6% vs. 38.8%; p < 0.001) was more common in eyes with DSM. Eyes with horizontal DSM had worse best-corrected logMAR visual acuity than eyes with round DSM (0.34 +/- 0.22 vs. 0.23 +/- 0.22; p = 0.03). DSM height (98.95 +/- 65.17 vs. 104.63 +/- 44.62 mu m; p = 0.05) was lower in the horizontal DSM. SFST (OR = 1.06, p = 0.04) and foveal choroidal vascularity index (OR = 0.711, p = 0.02) were significantly associated with DSM. DSM width (p < 0.001), foveal choroidal perfusion area (p = 0.01), foveal choriocapillaris perfusion area (p = 0.02) and parafoveal choroidal vascularity index (p = 0.03) were the most significantly associated factors with DSM height. Conclusions: The microcirculatory characteristics of eyes with DSM differed from those without DSM. Microcirculatory abnormalities were significantly associated with a DSM. The height of the DSM was associated with decreased blood perfusion.