CASE: Dome-shaped macula with chronic subretinal fluid

A 38 year-old high myope was referred for a persistent subretinal fluid (SRF) in the left eye. The patient had a series of three intravitreal Avastin injections for presumed myopic choroidal neovascular membrane (CNVM); however, the SRF did not appear to respond adequately to anti-VEGF treatment.
Upon examination and imaging, a dome-shaped macula (DSM) configuration was noted in both eyes. OCT showed shallow subfoveal fluid in the left eye with shaggy photoreceptors.
The differential at that point included myopic CNVM, central serous chorioretinopathy (CSCR), and SRF due to DSM. The patient denied any exogenous steroid use or increased levels of stress. Fluorescein angiography did not reveal any obvious CNV or areas of increased vascular permeability. The above, including poor response to anti-VEGF treatment, pointed away from the former two diagnoses and towards the latter.
Therefore, the patient was observed and asked to return in 8 weeks and instructed to use Amsler grid at home.
Upon repeat examination, the subretinal fluid decreased in its volume. Such SRF fluctuation without any treatment was more consistent with the etiology of the fluid arising from DSM rather than a choroidal neovascular proccess (CNVM) or related to increased vessel permeability (CSCR). Further observation was elected.


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