Advances in the formation mechanism of dome-shaped macula in highly myopic eyes and its association with myopic complications

Dome-shaped macula (DSM) mostly presents as an inward bulging of the macular area within the area of posterior staphyloma in highly myopic eyes.According to the optical coherence tomography results, DSM has been classified as vertical, horizontal and round type, but its formation mechanism is still controversial.The appearance of DSM was initially thought to be associated with low intraocular pressure and vitreous macular traction.There is growing support that DSM is an adaptive protective mechanism developed to resist the progression of myopia.However, recent studies suggest that the macular bulge may be the result of progressive asymmetric choroidal and scleral thinning in the surrounding area, rather than active inward bulging of the central macula.In addition, DSM in highly myopic eyes is often accompanied by a variety of myopic complications that lead to decreased visual acuity and visual impairment in the eye with DSM, such as serous retinal detachment, retinoschisis, choroidal neovascularization, macular hole and Bruch membrane defects.However, the causal relationship between DSM and myopic complications is unclear, and there are still no effective preventive measures or treatments for related complications.This article summarizes the mechanism of DSM formation in highly myopic eyes and its association with myopic complications to provide a theoretical basis for exploring the visual prognosis of patients with high myopia and the pathogenesis of DSM.

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