Melikhova M V, Gatsu M V, Boiko E V, Fokin V A, Trufanov G E
Saint Petersburg branch of S. Fyodorov Eye Microsurgery Federal State Institution, 21 Yaroslava Gasheka St., St. Petersburg, Russian Federation, 192283.
Saint Petersburg branch of S. Fyodorov Eye Microsurgery Federal State Institution, 21 Yaroslava Gasheka St., St. Petersburg, Russian Federation, 192283; North-Western State Medical University named after I.I Mechnikov, 41 Kirochnaya St., St. Petersburg, Russian Federation, 191015.
Vestn Oftalmol. 2018;134(3):86-94. doi: 10.17116/oftalma2018134386.
The phenomenon of dome-shaped macula (DSM) constitutes protrusion of membranes of the posterior pole of the eye toward the vitreous body due to local thickening of sclera layers. The phenomenon was detected using enhanced depth imaging optical coherence tomography (EDI-OCT). In uncomplicated forms of DSM, all layers of the retina are contiguous, but the setting of DSM can involve a number of pathological conditions causing decrease in vision. One of the most often described concurrent conditions in DSM is serous retinal detachment (SRD). Such complicated forms of DSM are often masked as a non-pigmented neoplasm of the choroid, in particular hemangioma (HC).
To demonstrate the possibilities of differential diagnostics of DSM with HC using modern instrumental diagnostic methods.
The study involved two clinical cases of patients with DSM and HC, who underwent comprehensive ophthalmological examination including EDI-OCT and OCT angiography, fluorescent angiography (FA), indocyanine-green angiography (ICG) and magnetic resonance imaging of brain and orbits (MRI).
The most simple and highly informative method for differential diagnostic of DSM with HC is currently EDI-OCT. In difficult differential diagnostic cases, it is recommended to use FA and MRI. Additionally, for identification of the cause of SRD in DSM, OCT-angiography and ICG-angiography can be used. Thus, diagnostics of DSM is difficult today primarily because of the low awareness of ophthalmologists about the presence of such macula pathology. Detection of this anatomical feature by means of ophthalmoscopy alone can be difficult and requires special skills and experience. The use of EDI-OCT, as well as FA and MRI in difficult differential diagnostic cases, and correct interpretation of the obtained data can help avoid diagnostic errors.
圆顶状黄斑（DSM）现象是由于巩膜层局部增厚导致眼球后极部膜向玻璃体突出。该现象通过增强深度成像光学相干断层扫描（EDI - OCT）检测到。在无并发症的DSM形式中，视网膜各层是连续的，但DSM的形成可能涉及多种导致视力下降的病理状况。DSM中最常描述的并发状况之一是浆液性视网膜脱离（SRD）。这种复杂形式的DSM常被误诊为脉络膜无色素性肿瘤，尤其是血管瘤（HC）。
利用现代仪器诊断方法展示DSM与HC的鉴别诊断可能性。
该研究纳入了两名患有DSM和HC的患者的临床病例，他们接受了全面的眼科检查，包括EDI - OCT、OCT血管造影、荧光血管造影（FA）、吲哚菁绿血管造影（ICG）以及脑部和眼眶的磁共振成像（MRI）。
目前，用于DSM与HC鉴别诊断的最简单且信息丰富的方法是EDI - OCT。在鉴别诊断困难的病例中，建议使用FA和MRI。此外，为了确定DSM中SRD的病因，可使用OCT血管造影和ICG血管造影。因此，如今DSM的诊断困难主要是因为眼科医生对这种黄斑病变的存在认识不足。仅通过检眼镜检测这种解剖特征可能困难，且需要特殊技能和经验。在鉴别诊断困难的病例中使用EDI - OCT以及FA和MRI，并正确解读所获数据，有助于避免诊断错误。
