Clinical, fundoscopic, tomographic and angiographic characteristics of dome shaped macula classified by bulge height | Archivos de la Sociedad Española de Oftalmología (English Edition)

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Groups B and C exhibited the lowest VA; with higher BH, lower VA (p<0.05)." ] ] ] "textoCompleto" => "IntroductionDome-shaped macula (DM) is an anatomical finding in continuous research. It was first defined by Gaucher et al. in 2008<a class="elsevierStyleCrossRef" href="#bib0045">1</a> as a convex macular bulge within the concavity of a posterior staphyloma in high myopics detected by optical coherence tomography (OCT). Also by means of OCT, Imamura et al. proposed that increased subfoveal scleral thickness could explain the dome shaped and obstruct the exit of normal choroidal flow and diminishing visual acuity (VA) due to the appearance of subfoveal serous detachment (SSD).<a class="elsevierStyleCrossRef" href="#bib0050">2</a> Accordingly, in recent years, SSD has become particularly relevant due to its potential impact on low VA that patients with high myopia and DM could exhibit. Caillaux<a class="elsevierStyleCrossRef" href="#bib0055">3</a> proposed a first hypothesis about SSD presentation on the basis of its frequency according to the size of the macular bulge height (BH). Said authors found a higher frequency of SSD in domes with BH above 350μm and proposed an association between the presence of SSD and diminished VA.The present study aims at classifying DM in 3 groups (lo medium and high) according to macular BH and to analyze the clinic, funduscopic, tomographic and angiographic characteristics of each group to identify the factors involved in the low VA of these patients.Patients and methodsClinical records of patients with high myopia diagnostic were selected (spherical equivalents of 6 negative diopters or more) from the Retina practice in a retrospective selection from March 2015 to March 2016. From this group, patients exhibiting DM were selected, defined as the anatomic complexity of the macula within posterior staphyloma having a minimum BH of 50μm as per the definitions by Ellabban<a class="elsevierStyleCrossRef" href="#bib0060">4</a> and Ohsugi.<a class="elsevierStyleCrossRef" href="#bib0065">5</a>DM images were obtained by OCT Cirrus Spectral Domain (Carl Zeiss Meditec, Dublin, CA, USA), and the search included images taken along the horizontal and vertical axis. Out of all the DM with high myopia found in the OCT archives, those fulfilling the following criteria were selected for the study: patients over 18 years of age, without concomitant retinal or systemic diseases that could affect the retina, without ophthalmological diseases that could affect VA (astigmatism, corneal scars, advanced cataracts, chronic glaucoma, etc.), who had not received to treatment with photodynamic therapy or retina or vitriol surgery.Fourteen out of 26 DM patients fulfilled the above inclusion criteria, of which only 9 had complete ophthalmological exploration and documentation in the clinical records on file. Three of said 9 patients exhibited bilateral DM, obtaining 15 eyes with DM and high myopia that fulfilled all necessary requirements and were admitted in the study.The classification of 15 eyes was carried out according to the Caillaux method: the OCT images were utilized for measuring BH through a vertical line (A) passing through the center of the fovea and the apex of the dome, followed by a horizontal line (B) tangential to the retina pigment epithelium (RPE) to coincide with the final boundaries of the dome (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Accordingly, BH was classified on the basis of the distance between the intersection of line A with the RPE up to the point of intersection of line B with line A. Said distances were classified in 3 groups: low (50–350μm), medium (351μm) and high BH (>650μm). Five of the 15 eyes exhibited low, 8 had medium and 2 had high BH. The characteristics of the 15 eyes can be seen in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Clinical record data were collected for the following variables: best corrected VA in the LogMar scale; autorefractometry; axial length measured by IOL Master; visual symptoms such as patient-referred central scotoma and presence of metamorphopsiae identified through the Amsler test; posterior pole funduscopic signs explored with pupil dilatation: macular hyperpigmentation, papilla macular bundle crests and obliquely implanted papilla; fluorescein angiography study: presence of SSD, identified as focal hyperfluorescent lesion with late leak, RPE atrophy and extension measured in papillary diameters, choroidal neovascularization; study with OCT Cirrus Spectral Domain: presence of SSD, RPE detachment, foveoschisis and choroidal neovascularization.The results were analyzed utilizing the statistics application SPSS version 23 (IBM SPSS Statistics for Windows, Version 23.0., IBM Corp, Armonk, NY). The variables were positive in the normality test and therefore parametric tests were applied for the statistical analysis. Error margin was p=0.09. The study complies with the statutes of the Helsinki Declaration.ResultsThe study included 15 patients, predominantly female (86%), with only 2 male patients. A greater frequency of patients over 50 was observed in the sample (66%). The main reason for consulting was diminishing VA (80%).The mean axial length measure was 27.2mm while the mean refractive error exhibited by the group was 11.8 negative diopters. No statistically significant relationship was observed between the presence of visual symptoms (patient-referred central scotoma or metamorphopsiae found with the Amsler test) and BH (p>0.05).Best corrected visual acuity according to the logMar scale was significantly lower with higher BH measured in microns, with a statistical significance of p<0.05, for which reason groups B and C were most affected (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). VA was also related to RPE atrophy; best corrected VA was significantly lower with higher RPE atrophy measured in papilla diameters (p<0.05) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Accordingly, when assessing the presence of SSD by means of OCT it was found that with BH above 400μm the presence of SSD was greater, with a statistical significance of p<0.05 (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia>In what concerns funduscopic signs, it was observed that 100% of cases exhibited obliquely implanted papilla. No significant differences were found between the presence of retinal crests and macular hyperpigmentation with BH (<a class="elsevierStyleCrossRefs" href="#fig0025">Figs. 5 and 6</a>). The statistical analysis of RPE detachment, foveoschisis and choroidal neovascularization observed through OCT did not demonstrate significant differences between groups A, B and C, in contrast with the above-mentioned presence of SSD which, observed by means of fluorescein angiography, was significantly higher with higher BH, for which reason it was present in study groups B and C (<a class="elsevierStyleCrossRef" href="#fig0035">Fig. 7</a>).<elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><elsevierMultimedia ident="fig0035"></elsevierMultimedia>Finally, the variables that showed statistical significance were analyzed utilizing Pearson's Chi square test to assess the association between them. It was observed that, with BH above 400μm, lower VA, greater presence of SSD and of RPE atrophy was found, with p<0.05.DiscussionIn several studies, the presence of DM in patients with high myopia was related to diminishing VA<a class="elsevierStyleCrossRefs" href="#bib0045">1–3</a> and the presence of associated complications. Of the clinic characteristics studied herein, axial length, refractive error, central scotoma vision and Amsler test did not exhibit significant differences between the 3 groups included in this analysis. However, VA was lower in eyes with DM having medium and high BH, in contrast with maculas lower than 400μm, that preserved over 50% best corrected VA (statistical significance, p=0.09). Overall, 95% of patients were female, which matches previous studies that reported higher prevalence of DM in females. An additional and noteworthy finding was that 73% of the eyes belonged to patients under 55 years of age. It has been proposed that the mechanism originating the presence of the dome could appear in youth and its development would depend on the adaptation of the macula to preserve VA despite myopic changes taking place. However, a study that would enable a prospective identification of changes and lesions in young patients with high myopia parents or with high myopia would be required to verify said hypothesis.As regards funduscopic signs, the authors based their findings on the lesions described and proposed by Chia<a class="elsevierStyleCrossRef" href="#bib0070">6</a> for characterizing domes, i.e., the presence of yellow folds in the papilla macular bundle, oblique implantation of the papilla and increased macular pigment. In the present analysis, oblique papilla was found in all eyes with DM while yellow folds or crests were observed in 33% of the eyes, making it an inconstant characteristic of examinations. In addition, the presence of crests was only found in domes above 500μm, leading the authors to think that the folds could occur due to the mechanical stretching endured by the bundle between an abnormally high macula and the oblique implantation of the optic nerve. Macular pigment was present in 20% of eyes with DM. However, the authors conclude that this finding is not assessable in maculas with high myopia due to the considerable morphological changes endured by these eyes with intense myopic choroidosis and presence of Fuchs plates.SSD without the presence of choroidal neovascularization is a complication described as accounting for diminishing VA in myopic eyes with DM, despite being infrequent in myopic eyes without the presence of the dome.<a class="elsevierStyleCrossRefs" href="#bib0045">1,2,4,7</a>According to the present analysis, the presence of SSD observed through OCT images is related to the height of the dome. Accordingly, the presence of said complication was more frequent in domes over 400μm high, i.e., in the medium and high dome groups. This measure was higher to that studied by Caillaux,<a class="elsevierStyleCrossRef" href="#bib0055">3</a> who adopted 350μ as threshold. Another interesting aspect of the analysis was the presentation of RPE atrophy. The fluorescein angiography test showed that said atrophy occurred and occupied one papillary diameter or more in the perifoveal macular region after BH values of 400μm. The analysis demonstrated a statistically significant relationship (p<0.05) between BH, the presence of SSD and RPE atrophy, a relationship in which, with higher domes, SSD is found more frequently and RPE atrophy is larger.On the basis of the above results, the following hypothesis is proposed: a sequential evolution of DM lesions with BH above 400μm could exist, wherein RPE atrophy produced by anatomic macular deformation would enable the appearance and assistance of SSD, with ensuing VA reduction. Said atrophy would be the initial damage and trigger of this pathogenic sequence and the possible cause of the poor response to known therapies.SSD was associated to the presence of a late leak point in fluorescein angiography and 77% of cases. These hyperfluorescent lesions were observed in the same location as the RPE atrophy zones, reminiscent of a pattern very similar to central serous choroidosis as described by Gaucher<a class="elsevierStyleCrossRef" href="#bib0045">1</a> and Viola<a class="elsevierStyleCrossRef" href="#bib0080">8</a> (<a class="elsevierStyleCrossRef" href="#fig0035">Fig. 7</a>). Even so, it should be emphasized that the local lesion due to late leak in fluorescein angiography observed in DM is a unique lesion located in the dome apex, whereas in the case of central serous choroidosis said findings are more extended and closer to the vascular arcs.<a class="elsevierStyleCrossRef" href="#bib0080">8</a> The focal late leak lesion in fluorescein angiography reinforces the hypothesis that the origin of SSD could be closely linked to RPE atrophy and to the localized changes in the subfoveal choroids and that, in turn, these changes are secondary to the dome shape of the macula.It is worthy of note that, among others, Imamura et al.<a class="elsevierStyleCrossRef" href="#bib0050">2</a> found that the sclera exhibited selective subfoveal thickening matching choroidal changes and the presence of the dome. The persistence of this scleral thickening could be capable of producing anatomical changes over the choroids and the retina which in turn would cause vascular lesions in the choroids and RPE atrophy described in the present study. Said alterations would allow the appearance of SSD within the dome due to the slow choroidal vascular leak and the sequence of the involvements described above.The main limitation of the present study is sample size. As the entity has a low prevalence and the inclusion criteria were highly specific, the number of analyzed eyes gave a low n. A study with n above 15 and endeavoring to diminish the participation of both eyes would be desirable to obtain an even more specific analysis with less bias probability.The present study did not observe eyes with choroidal neovascularization or foveoschisis.Conflict of interestsNo conflict of interests was declared by the authors." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres906134" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec886573" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres906133" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec886574" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-01-29" "fechaAceptado" => "2017-03-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec886573" "palabras" => array:7 [ 0 => "Dome shaped macula" 1 => "Bulge height" 2 => "Foveal serous detachment" 3 => "High myopia" 4 => "Pathological myopia" 5 => "Fluorescein angiography" 6 => "Optical coherence tomography" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec886574" "palabras" => array:6 [ 0 => "Mácula en domo" 1 => "Altura de protrusión macular" 2 => "Miopía magna" 3 => "Desprendimiento seroso foveal" 4 => "Angiografía fluoresceínica" 5 => "Tomografía de coherencia óptica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo classify dome shaped macula cases by their bulge height (BH). To analyze the characteristics associated with the groups formed by this classification. MethodsObservational, descriptive and cross-sectional study on 15 selected eyes with dome shaped macula and high myopia. Using Caillaux method and optical coherence tomography images, 3 groups were determined by their BH: low (50–350μm), medium (351–650μm), and high (>650μm), and a study of visual acuity, axial length, presence of subfoveal serous detachment, and images by fluorescein angiography and optic coherence tomography, as main variables. The confidence interval was 95%. ResultsBy using the chi-squared test, the study showed that a BH higher than 400μm was associated with lower visual acuity, presence of subfoveal serous detachment, and greater atrophy of the retinal pigment epithelium measured by disk diameters (p<0.05). ConclusionsThe medium and high BH showed a positive correlation with the presence of foveal serous detachment and a lower visual acuity." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoClasificar la mácula en domo según la altura de protrusión macular (AP) y analizar las características asociadas a cada grupo. MétodosEstudio observacional, descriptivo y transversal. Selección de 15 ojos con mácula en domo y miopía magna. Utilizando imágenes por tomografía de coherencia óptica (OCT) y el método de Caillaux, se clasificó la AP en baja (50-350μ), media (351-650μ) y alta (>650μ) y se estudió la agudeza visual, longitud axial, presencia de desprendimiento seroso subfoveal y las imágenes obtenidas por angiografía fluoresceínica y OCT como variables principales. El nivel de confianza utilizado fue de 95%. ResultadosUtilizando el test de chi cuadrado, el estudio observó que una AP mayor a 400μ se asoció con menor agudeza visual, mayor presencia de desprendimiento seroso subfoveal y mayor presencia de atrofia del epitelio pigmentario de la retina medida en diámetros de papila (p<0,05). ConclusionesLas AP media y alta mostraron una asociación positiva con la presencia de desprendimiento seroso subfoveal y disminución de laagudeza visual." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Fajardo Sánchez J, Chau Ramos CE, Roca Fernández JA, Urcelay Segura JL. Estudio de las características clínicas, fundoscópicas, tomográficas y angiográficas de la mácula en domo según la altura de protrusión macular. Arch Soc Esp Oftalmol. 2017;92:458–463." ] ] "multimedia" => array:8 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1070 "Ancho" => 1750 "Tamanyo" => 137160 ] ] "descripcion" => array:1 [ "en" => "Caillaux method for measuring BH tracing a vertical line (A) passing through the center of the fovea and the dome apex, subsequently tracing a horizontal line (B) tangential to the RPE matching the final lines of the dome. BH was the shortest vertical distance between the intersection of line A with the fovea and line B (OCT image from the article published by Caillaux<a class="elsevierStyleCrossRef" href="#bib0055">3</a>)." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 891 "Ancho" => 1599 "Tamanyo" => 66859 ] ] "descripcion" => array:1 [ "en" => "Bar graph describing best corrected VA for the 3 analyze groups. Groups B and C exhibited the lowest VA; with higher BH, lower VA (p<0.05)." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 874 "Ancho" => 1578 "Tamanyo" => 71556 ] ] "descripcion" => array:1 [ "en" => "Bar graph. BA in relation to the extension of RPE atrophy; best corrected VA was significantly lower with higher RPE atrophy measured in papilla diameters (p<0.05)." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 849 "Ancho" => 1544 "Tamanyo" => 67818 ] ] "descripcion" => array:1 [ "en" => "Bar graph. The presence of SSD (OCT) was higher when BA exceeded 400μm, with statistical significance of p<0.05." ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 854 "Ancho" => 1138 "Tamanyo" => 119271 ] ] "descripcion" => array:1 [ "en" => "Retinograph showing oblique papilla and presence of crests in the papillomacular bundle in a patient with high myopia." ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Fig. 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 856 "Ancho" => 1138 "Tamanyo" => 104160 ] ] "descripcion" => array:1 [ "en" => "Retinograph showing macular hyperpigmentation presence of crests in the papillomacular bundle." ] ] 6 => array:7 [ "identificador" => "fig0035" "etiqueta" => "Fig. 7" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr7.jpeg" "Alto" => 853 "Ancho" => 1138 "Tamanyo" => 112506 ] ] "descripcion" => array:1 [ "en" => "Fluorescein angiograph showing local leak point at the dome apex." ] ] 7 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "FAG: fluorescein angiography; ARF: autorefractometer; BCVA: best corrected visual acuity; BH: bulge height (macular protrusion height); SSD: serous subfoveal detachment; RPE: retina pigment epithelium; PM bundle: papillomacular bundle; CNV: choroidal neovascularization; OCT: optical coherence tomography.1: said characteristic/lesion is present.2: said characteristic/lesion is not present.RPE atrophy: 0=under 1 papilla diameter; 1=1 papilla diameter; 2=2 or more papilla diameters." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"># \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Age/sex \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Groups \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Macula BH μm \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Far BCVA logmar \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">ARF \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Axial length \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Central scotoma \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Amsler \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Macular hyperpig. \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Crests PM bundle \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">SSD FAG \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Atrophy RPE \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">SSD OCT \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">DEP OCT \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CNV OCT \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">43 f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">193 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">42 f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">202 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">42 f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">292 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49 f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">270 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48 f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">348 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">58 m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">430 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48 f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">446 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">60 m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">457 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48 f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">552 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">47 f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">480 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">62 f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">512 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50 f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">703 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">51 f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">607 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48 f \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">811 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" 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Clinical, fundoscopic, tomographic and angiographic characteristics of dome shaped macula classified by bulge height

Estudio de las características clínicas, fundoscópicas, tomográficas y angiográficas de la mácula en domo según la altura de protrusión macular

J. Fajardo Sáncheza,

Corresponding author

juliafajardo7@gmail.com

Corresponding author.

, C.E. Chau Ramosa, J.A. Roca Fernándezb, J.L. Urcelay Seguraa

a Servicio de Oftalmología, Hospital General Universitario Gregorio Marañón, Instituto Provincial de Oftalmología, Madrid, Spain

b Clínica Ricardo Palma, Lima, Peru

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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Bar graph describing best corrected VA for the 3 analyze groups&#46; Groups B and C exhibited the lowest VA&#59; with higher BH&#44; lower VA &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Dome-shaped macula &#40;DM&#41; is an anatomical finding in continuous research&#46; It was first defined by Gaucher et al&#46; in 2008<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> as a convex macular bulge within the concavity of a posterior staphyloma in high myopics detected by optical coherence tomography &#40;OCT&#41;&#46; Also by means of OCT&#44; Imamura et al&#46; proposed that increased subfoveal scleral thickness could explain the dome shaped and obstruct the exit of normal choroidal flow and diminishing visual acuity &#40;VA&#41; due to the appearance of subfoveal serous detachment &#40;SSD&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> Accordingly&#44; in recent years&#44; SSD has become particularly relevant due to its potential impact on low VA that patients with high myopia and DM could exhibit&#46; Caillaux<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> proposed a first hypothesis about SSD presentation on the basis of its frequency according to the size of the macular bulge height &#40;BH&#41;&#46; Said authors found a higher frequency of SSD in domes with BH above 350<span class="elsevierStyleHsp" style=""></span>&#956;m and proposed an association between the presence of SSD and diminished VA&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The present study aims at classifying DM in 3 groups &#40;lo medium and high&#41; according to macular BH and to analyze the clinic&#44; funduscopic&#44; tomographic and angiographic characteristics of each group to identify the factors involved in the low VA of these patients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">Clinical records of patients with high myopia diagnostic were selected &#40;spherical equivalents of 6 negative diopters or more&#41; from the Retina practice in a retrospective selection from March 2015 to March 2016&#46; From this group&#44; patients exhibiting DM were selected&#44; defined as the anatomic complexity of the macula within posterior staphyloma having a minimum BH of 50<span class="elsevierStyleHsp" style=""></span>&#956;m as per the definitions by Ellabban<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> and Ohsugi&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">DM images were obtained by OCT <span class="elsevierStyleItalic">Cirrus Spectral Domain &#40;Carl Zeiss Meditec&#44; Dublin&#44; CA&#44; USA&#41;</span>&#44; and the search included images taken along the horizontal and vertical axis&#46; Out of all the DM with high myopia found in the OCT archives&#44; those fulfilling the following criteria were selected for the study&#58; patients over 18 years of age&#44; without concomitant retinal or systemic diseases that could affect the retina&#44; without ophthalmological diseases that could affect VA &#40;astigmatism&#44; corneal scars&#44; advanced cataracts&#44; chronic glaucoma&#44; etc&#46;&#41;&#44; who had not received to treatment with photodynamic therapy or retina or vitriol surgery&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Fourteen out of 26 DM patients fulfilled the above inclusion criteria&#44; of which only 9 had complete ophthalmological exploration and documentation in the clinical records on file&#46; Three of said 9 patients exhibited bilateral DM&#44; obtaining 15 eyes with DM and high myopia that fulfilled all necessary requirements and were admitted in the study&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The classification of 15 eyes was carried out according to the Caillaux method&#58; the OCT images were utilized for measuring BH through a vertical line &#40;A&#41; passing through the center of the fovea and the apex of the dome&#44; followed by a horizontal line &#40;B&#41; tangential to the retina pigment epithelium &#40;RPE&#41; to coincide with the final boundaries of the dome &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Accordingly&#44; BH was classified on the basis of the distance between the intersection of line A with the RPE up to the point of intersection of line B with line A&#46; Said distances were classified in 3 groups&#58; low &#40;50&#8211;350<span class="elsevierStyleHsp" style=""></span>&#956;m&#41;&#44; medium &#40;351<span class="elsevierStyleHsp" style=""></span>&#956;m&#41; and high BH &#40;&#62;650<span class="elsevierStyleHsp" style=""></span>&#956;m&#41;&#46; Five of the 15 eyes exhibited low&#44; 8 had medium and 2 had high BH&#46; The characteristics of the 15 eyes can be seen in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Clinical record data were collected for the following variables&#58; best corrected VA in the LogMar scale&#59; autorefractometry&#59; axial length measured by IOL Master&#59; visual symptoms such as patient-referred central scotoma and presence of metamorphopsiae identified through the Amsler test&#59; posterior pole funduscopic signs explored with pupil dilatation&#58; macular hyperpigmentation&#44; papilla macular bundle crests and obliquely implanted papilla&#59; fluorescein angiography study&#58; presence of SSD&#44; identified as focal hyperfluorescent lesion with late leak&#44; RPE atrophy and extension measured in papillary diameters&#44; choroidal neovascularization&#59; study with OCT <span class="elsevierStyleItalic">Cirrus Spectral Domain</span>&#58; presence of SSD&#44; RPE detachment&#44; foveoschisis and choroidal neovascularization&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The results were analyzed utilizing the statistics application SPSS version 23 &#40;IBM SPSS Statistics for Windows&#44; Version 23&#46;0&#46;&#44; IBM Corp&#44; Armonk&#44; NY&#41;&#46; The variables were positive in the normality test and therefore parametric tests were applied for the statistical analysis&#46; Error margin was <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;09&#46; The study complies with the statutes of the Helsinki Declaration&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">The study included 15 patients&#44; predominantly female &#40;86&#37;&#41;&#44; with only 2 male patients&#46; A greater frequency of patients over 50 was observed in the sample &#40;66&#37;&#41;&#46; The main reason for consulting was diminishing VA &#40;80&#37;&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The mean axial length measure was 27&#46;2<span class="elsevierStyleHsp" style=""></span>mm while the mean refractive error exhibited by the group was 11&#46;8 negative diopters&#46; No statistically significant relationship was observed between the presence of visual symptoms &#40;patient-referred central scotoma or metamorphopsiae found with the Amsler test&#41; and BH &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Best corrected visual acuity according to the logMar scale was significantly lower with higher BH measured in microns&#44; with a statistical significance of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#44; for which reason groups B and <span class="elsevierStyleSmallCaps">C</span> were most affected &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; VA was also related to RPE atrophy&#59; best corrected VA was significantly lower with higher RPE atrophy measured in papilla diameters &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Accordingly&#44; when assessing the presence of SSD by means of OCT it was found that with BH above 400<span class="elsevierStyleHsp" style=""></span>&#956;m the presence of SSD was greater&#44; with a statistical significance of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">In what concerns funduscopic signs&#44; it was observed that 100&#37; of cases exhibited obliquely implanted papilla&#46; No significant differences were found between the presence of retinal crests and macular hyperpigmentation with BH &#40;<a class="elsevierStyleCrossRefs" href="#fig0025">Figs&#46; 5 and 6</a>&#41;&#46; The statistical analysis of RPE detachment&#44; foveoschisis and choroidal neovascularization observed through OCT did not demonstrate significant differences between groups A&#44; B and C&#44; in contrast with the above-mentioned presence of SSD which&#44; observed by means of fluorescein angiography&#44; was significantly higher with higher BH&#44; for which reason it was present in study groups B and C &#40;<a class="elsevierStyleCrossRef" href="#fig0035">Fig&#46; 7</a>&#41;&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><elsevierMultimedia ident="fig0035"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Finally&#44; the variables that showed statistical significance were analyzed utilizing Pearson&#39;s Chi square test to assess the association between them&#46; It was observed that&#44; with BH above 400<span class="elsevierStyleHsp" style=""></span>&#956;m&#44; lower VA&#44; greater presence of SSD and of RPE atrophy was found&#44; with <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">In several studies&#44; the presence of DM in patients with high myopia was related to diminishing VA<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#8211;3</span></a> and the presence of associated complications&#46; Of the clinic characteristics studied herein&#44; axial length&#44; refractive error&#44; central scotoma vision and Amsler test did not exhibit significant differences between the 3 groups included in this analysis&#46; However&#44; VA was lower in eyes with DM having medium and high BH&#44; in contrast with maculas lower than 400<span class="elsevierStyleHsp" style=""></span>&#956;m&#44; that preserved over 50&#37; best corrected VA &#40;statistical significance&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;09&#41;&#46; Overall&#44; 95&#37; of patients were female&#44; which matches previous studies that reported higher prevalence of DM in females&#46; An additional and noteworthy finding was that 73&#37; of the eyes belonged to patients under 55 years of age&#46; It has been proposed that the mechanism originating the presence of the dome could appear in youth and its development would depend on the adaptation of the macula to preserve VA despite myopic changes taking place&#46; However&#44; a study that would enable a prospective identification of changes and lesions in young patients with high myopia parents or with high myopia would be required to verify said hypothesis&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">As regards funduscopic signs&#44; the authors based their findings on the lesions described and proposed by Chia<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> for characterizing domes&#44; i&#46;e&#46;&#44; the presence of yellow folds in the papilla macular bundle&#44; oblique implantation of the papilla and increased macular pigment&#46; In the present analysis&#44; oblique papilla was found in all eyes with DM while yellow folds or crests were observed in 33&#37; of the eyes&#44; making it an inconstant characteristic of examinations&#46; In addition&#44; the presence of crests was only found in domes above 500<span class="elsevierStyleHsp" style=""></span>&#956;m&#44; leading the authors to think that the folds could occur due to the mechanical stretching endured by the bundle between an abnormally high macula and the oblique implantation of the optic nerve&#46; Macular pigment was present in 20&#37; of eyes with DM&#46; However&#44; the authors conclude that this finding is not assessable in maculas with high myopia due to the considerable morphological changes endured by these eyes with intense myopic choroidosis and presence of Fuchs plates&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">SSD without the presence of choroidal neovascularization is a complication described as accounting for diminishing VA in myopic eyes with DM&#44; despite being infrequent in myopic eyes without the presence of the dome&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1&#44;2&#44;4&#44;7</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">According to the present analysis&#44; the presence of SSD observed through OCT images is related to the height of the dome&#46; Accordingly&#44; the presence of said complication was more frequent in domes over 400<span class="elsevierStyleHsp" style=""></span>&#956;m high&#44; i&#46;e&#46;&#44; in the medium and high dome groups&#46; This measure was higher to that studied by Caillaux&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> who adopted 350<span class="elsevierStyleHsp" style=""></span>&#956; as threshold&#46; Another interesting aspect of the analysis was the presentation of RPE atrophy&#46; The fluorescein angiography test showed that said atrophy occurred and occupied one papillary diameter or more in the perifoveal macular region after BH values of 400<span class="elsevierStyleHsp" style=""></span>&#956;m&#46; The analysis demonstrated a statistically significant relationship &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; between BH&#44; the presence of SSD and RPE atrophy&#44; a relationship in which&#44; with higher domes&#44; SSD is found more frequently and RPE atrophy is larger&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">On the basis of the above results&#44; the following hypothesis is proposed&#58; a sequential evolution of DM lesions with BH above 400<span class="elsevierStyleHsp" style=""></span>&#956;m could exist&#44; wherein RPE atrophy produced by anatomic macular deformation would enable the appearance and assistance of SSD&#44; with ensuing VA reduction&#46; Said atrophy would be the initial damage and trigger of this pathogenic sequence and the possible cause of the poor response to known therapies&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">SSD was associated to the presence of a late leak point in fluorescein angiography and 77&#37; of cases&#46; These hyperfluorescent lesions were observed in the same location as the RPE atrophy zones&#44; reminiscent of a pattern very similar to central serous choroidosis as described by Gaucher<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> and Viola<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0035">Fig&#46; 7</a>&#41;&#46; Even so&#44; it should be emphasized that the local lesion due to late leak in fluorescein angiography observed in DM is a unique lesion located in the dome apex&#44; whereas in the case of central serous choroidosis said findings are more extended and closer to the vascular arcs&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> The focal late leak lesion in fluorescein angiography reinforces the hypothesis that the origin of SSD could be closely linked to RPE atrophy and to the localized changes in the subfoveal choroids and that&#44; in turn&#44; these changes are secondary to the dome shape of the macula&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">It is worthy of note that&#44; among others&#44; Imamura et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> found that the sclera exhibited selective subfoveal thickening matching choroidal changes and the presence of the dome&#46; The persistence of this scleral thickening could be capable of producing anatomical changes over the choroids and the retina which in turn would cause vascular lesions in the choroids and RPE atrophy described in the present study&#46; Said alterations would allow the appearance of SSD within the dome due to the slow choroidal vascular leak and the sequence of the involvements described above&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The main limitation of the present study is sample size&#46; As the entity has a low prevalence and the inclusion criteria were highly specific&#44; the number of analyzed eyes gave a low <span class="elsevierStyleItalic">n</span>&#46; A study with n above 15 and endeavoring to diminish the participation of both eyes would be desirable to obtain an even more specific analysis with less bias probability&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The present study did not observe eyes with choroidal neovascularization or foveoschisis&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interests</span><p id="par0115" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:10 [
        0 => array:3 [
          "identificador" => "xres906134"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Objective"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Methods"
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            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
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            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusions"
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          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec886573"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres906133"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Objetivo"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "M&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec886574"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Patients and methods"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Results"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discussion"
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          "identificador" => "sec0025"
          "titulo" => "Conflict of interests"
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        9 => array:1 [
          "titulo" => "References"
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      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-01-29"
    "fechaAceptado" => "2017-03-08"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec886573"
          "palabras" => array:7 [
            0 => "Dome shaped macula"
            1 => "Bulge height"
            2 => "Foveal serous detachment"
            3 => "High myopia"
            4 => "Pathological myopia"
            5 => "Fluorescein angiography"
            6 => "Optical coherence tomography"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec886574"
          "palabras" => array:6 [
            0 => "M&#225;cula en domo"
            1 => "Altura de protrusi&#243;n macular"
            2 => "Miop&#237;a magna"
            3 => "Desprendimiento seroso foveal"
            4 => "Angiograf&#237;a fluoresce&#237;nica"
            5 => "Tomograf&#237;a de coherencia &#243;ptica"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To classify dome shaped macula cases by their bulge height &#40;BH&#41;&#46; To analyze the characteristics associated with the groups formed by this classification&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Observational&#44; descriptive and cross-sectional study on 15 selected eyes with dome shaped macula and high myopia&#46; Using Caillaux method and optical coherence tomography images&#44; 3 groups were determined by their BH&#58; low &#40;50&#8211;350<span class="elsevierStyleHsp" style=""></span>&#956;m&#41;&#44; medium &#40;351&#8211;650<span class="elsevierStyleHsp" style=""></span>&#956;m&#41;&#44; and high &#40;&#62;650<span class="elsevierStyleHsp" style=""></span>&#956;m&#41;&#44; and a study of visual acuity&#44; axial length&#44; presence of subfoveal serous detachment&#44; and images by fluorescein angiography and optic coherence tomography&#44; as main variables&#46; The confidence interval was 95&#37;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">By using the chi-squared test&#44; the study showed that a BH higher than 400<span class="elsevierStyleHsp" style=""></span>&#956;m was associated with lower visual acuity&#44; presence of subfoveal serous detachment&#44; and greater atrophy of the retinal pigment epithelium measured by disk diameters &#40;<span class="elsevierStyleItalic">p<span class="elsevierStyleHsp" style=""></span></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The medium and high BH showed a positive correlation with the presence of foveal serous detachment and a lower visual acuity&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Clasificar la m&#225;cula en domo seg&#250;n la altura de protrusi&#243;n macular &#40;AP&#41; y analizar las caracter&#237;sticas asociadas a cada grupo&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional&#44; descriptivo y transversal&#46; Selecci&#243;n de 15 ojos con m&#225;cula en domo y miop&#237;a magna&#46; Utilizando im&#225;genes por tomograf&#237;a de coherencia &#243;ptica &#40;OCT&#41; y el m&#233;todo de Caillaux&#44; se clasific&#243; la AP en baja &#40;50-350<span class="elsevierStyleHsp" style=""></span>&#956;&#41;&#44; media &#40;351-650<span class="elsevierStyleHsp" style=""></span>&#956;&#41; y alta &#40;&#62;650<span class="elsevierStyleHsp" style=""></span>&#956;&#41; y se estudi&#243; la agudeza visual&#44; longitud axial&#44; presencia de desprendimiento seroso subfoveal y las im&#225;genes obtenidas por angiograf&#237;a fluoresce&#237;nica y OCT como variables principales&#46; El nivel de confianza utilizado fue de 95&#37;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Utilizando el test de chi cuadrado&#44; el estudio observ&#243; que una AP mayor a 400<span class="elsevierStyleHsp" style=""></span>&#956; se asoci&#243; con menor agudeza visual&#44; mayor presencia de desprendimiento seroso subfoveal y mayor presencia de atrofia del epitelio pigmentario de la retina medida en di&#225;metros de papila &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Las AP media y alta mostraron una asociaci&#243;n positiva con la presencia de desprendimiento seroso subfoveal y disminuci&#243;n de laagudeza visual&#46;</p></span>"
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            "titulo" => "Resultados"
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            "titulo" => "Conclusiones"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Fajardo S&#225;nchez J&#44; Chau Ramos CE&#44; Roca Fern&#225;ndez JA&#44; Urcelay Segura JL&#46; Estudio de las caracter&#237;sticas cl&#237;nicas&#44; fundosc&#243;picas&#44; tomogr&#225;ficas y angiogr&#225;ficas de la m&#225;cula en domo seg&#250;n la altura de protrusi&#243;n macular&#46; Arch Soc Esp Oftalmol&#46; 2017&#59;92&#58;458&#8211;463&#46;</p>"
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    ]
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      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
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            "imagen" => "gr1.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Caillaux method for measuring BH tracing a vertical line &#40;A&#41; passing through the center of the fovea and the dome apex&#44; subsequently tracing a horizontal line &#40;B&#41; tangential to the RPE matching the final lines of the dome&#46; BH was the shortest vertical distance between the intersection of line A with the fovea and line B &#40;OCT image from the article published by Caillaux<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a>&#41;&#46;</p>"
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      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Fig&#46; 2"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Bar graph describing best corrected VA for the 3 analyze groups&#46; Groups B and C exhibited the lowest VA&#59; with higher BH&#44; lower VA &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p>"
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        "identificador" => "fig0015"
        "etiqueta" => "Fig&#46; 3"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Bar graph&#46; BA in relation to the extension of RPE atrophy&#59; best corrected VA was significantly lower with higher RPE atrophy measured in papilla diameters &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p>"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Bar graph&#46; The presence of SSD &#40;OCT&#41; was higher when BA exceeded 400<span class="elsevierStyleHsp" style=""></span>&#956;m&#44; with statistical significance of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p>"
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Retinograph showing oblique papilla and presence of crests in the papillomacular bundle in a patient with high myopia&#46;</p>"
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      5 => array:7 [
        "identificador" => "fig0030"
        "etiqueta" => "Fig&#46; 6"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
          0 => array:4 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Retinograph showing macular hyperpigmentation presence of crests in the papillomacular bundle&#46;</p>"
        ]
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      6 => array:7 [
        "identificador" => "fig0035"
        "etiqueta" => "Fig&#46; 7"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Fluorescein angiograph showing local leak point at the dome apex&#46;</p>"
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      7 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">FAG&#58; fluorescein angiography&#59; ARF&#58; autorefractometer&#59; BCVA&#58; best corrected visual acuity&#59; BH&#58; bulge height &#40;macular protrusion height&#41;&#59; SSD&#58; serous subfoveal detachment&#59; RPE&#58; retina pigment epithelium&#59; PM bundle&#58; papillomacular bundle&#59; CNV&#58; choroidal neovascularization&#59; OCT&#58; optical coherence tomography&#46;</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">1&#58; said characteristic&#47;lesion is present&#46;</p><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">2&#58; said characteristic&#47;lesion is not present&#46;</p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">RPE atrophy&#58; 0<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>under 1 papilla diameter&#59; 1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1 papilla diameter&#59; 2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2 or more papilla diameters&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#35;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Age&#47;sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Groups&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Macula BH &#956;m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Far BCVA logmar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">ARF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Axial length&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Central scotoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Amsler&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Macular hyperpig&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Crests PM bundle&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">SSD FAG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Atrophy RPE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">SSD OCT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">DEP OCT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CNV OCT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43 f&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">193&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
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