**3.4 Dome-shaped macula**

Dome-shaped macula (DSM) is an inward protrusion of the macula as visualized by OCT (**Figure 6**). Different patterns have been described by OCT: a horizontal or vertical oval-shaped dome and a round dome [43]. DSM was first reported in myopic eyes with posterior staphyloma, but more recently has also been described

**Figure 6.** *SD-OCT showing a dome-shaped macula.*

in patients without staphyloma, emmetropic, or hypermetropic eyes [44, 45]. A variety of hypotheses have been postulated to explain it: an adaptive mechanism to minimize defocus in highly myopic eyes [46], vitreomacular traction [47], ocular hypotony [47], resistance of the sclera to the staphylomatous deformation [48], or localized choroidal thickening [48]. However, it has been recently indicated that the main problem is the different degrees of scleral thinning in the foveal region [46, 49, 50]. Subretinal fluid (SRF) in the fovea has been associated continuously with DSM in 28.5–66.6% of patients [51]. It may be due to RPE dysfunction [48] or as a consequence of not uniform scleral thickness that can affect choroidal fluid [46]. Although photodynamic therapy and anti-VEGF agents have been applied, they had no effects in terms of improvement in BCVA and resolution of SRF, because the fluid remained chronic and stable in most of the eyes over time [51], and it was even spontaneously resolved in 47% of the cases [52].
