Department of Ophthalmology, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain.
Miranza Corporation, Madrid, Spain.
Ophthalmologica. 2023;246(2):107-112. doi: 10.1159/000528993. Epub 2023 Jan 18.
The aim of this study was to analyze the atrophic, tractional, and neovascular (ATN) components grading in highly myopic patients with dome-shaped macula (DSM) and ridge-shaped macula (RSM).
This was a cross-sectional, noninterventional study. 57 eyes of 38 different patients were included. They were classified as DSM or RSM based on the number of radial scans that showed an inward protrusion ≥50 µm in the swept-source optical coherence tomography (SS-OCT) (12 = DSM; <12 = RSM). All patients underwent a complete ophthalmological examination in addition to SS-OCT. They were graded using the ATN system for myopic maculopathy by 2 masked retina specialists that assessed the atrophic (A), tractional (T), and neovascular (N) components in order to analyze the differences between the groups. As complementary measurements, age, axial length, and best-corrected visual acuity were collected. Height and orientation of the macular bulge and the presence of Bruch's membrane defects, scleral perforating vessels, and staphyloma were recorded.
Out of total 57 eyes, 13 eyes (22.8%) were classified as DSM. Regarding the atrophic component (A), there were statistically significant differences between groups, with DSM group showing a greater stage of atrophy (predominantly stage A3 in 69.2% of the sample) compared to the RSM group (predominantly stage A2 in 61.3% of the sample) (p < 0.05). For the T and N components, there were no significant differences between groups. The presence of Bruch's membrane defects was more frequently seen in DSM (p < 0.05).
DSM group showed more Bruch's membrane defects and a greater stage of the atrophy component, based on the ATN grading system, compared with RSM group. As Bruch's membrane may have biomechanical properties in terms of strength, the defects found around the macula, added to the major atrophic component, may be a cause of a local relaxation that induce a central bulge forming the dome.
本研究旨在分析高度近视伴盘状黄斑（DSM）和脊状黄斑（RSM）患者的萎缩性、牵拉性和新生血管性（ATN）成分分级。
这是一项横断面、非干预性研究。共纳入 38 例患者的 57 只眼。根据扫频源光学相干断层扫描（SS-OCT）中显示向内突起≥50 µm 的放射状扫描数量，将其分为 DSM 或 RSM（12 = DSM；<12 = RSM）。所有患者均接受全面眼科检查和 SS-OCT 检查。两名盲法视网膜专家使用 ATN 系统对近视性黄斑病变进行分级，评估萎缩性（A）、牵拉性（T）和新生血管性（N）成分，以分析两组间的差异。作为补充测量，收集年龄、眼轴长度和最佳矫正视力。记录黄斑隆起的高度和方向以及 Bruch 膜缺陷、巩膜穿通血管和葡萄肿的存在。
在总共 57 只眼中，有 13 只眼（22.8%）被归类为 DSM。在萎缩性成分（A）方面，两组间存在统计学显著差异，DSM 组的萎缩程度更大（69.2%的样本主要为 A3 期），而 RSM 组（61.3%的样本主要为 A2 期）（p < 0.05）。对于 T 和 N 成分，两组间无显著差异。DSM 组中更常出现 Bruch 膜缺陷（p < 0.05）。
与 RSM 组相比，DSM 组基于 ATN 分级系统显示出更多的 Bruch 膜缺陷和更大的萎缩性成分阶段。由于 Bruch 膜在强度方面可能具有生物力学特性，因此在黄斑周围发现的缺陷加上主要的萎缩性成分可能是导致局部松弛的原因，从而导致中央隆起形成穹顶。
