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dome - shaped macula ( dsm ) was first described in 2008 using optical coherence tomography ( oct ) by gaucher et al.1 this condition involves a protrusion of the macula within a staphyloma in highly myopic eyes , which causes visual impairment associated with serous foveal detachment ( sfd).2 although the pathogenesis of dsm remains unclear , imamura et al3 showed that dsm was associated with a relative localized thickness variation of the sclera under the macula .
recently , caillaux et al4 demonstrated that chronic sfd was associated with decreased vision and was more common when the macular bulge was highly elevated .
, we describe a patient with spontaneous resolution of sfd in dsm documented by serial spectral domain oct ( sd - oct ) .
a 28-year - old female japanese patient with no previous history of ocular disease was referred to our hospital 14 days after complaining of blurred vision in both eyes .
she reported that she had flu - like symptoms 7 days before the initial visit . upon initial examination ,
her best corrected visual acuity ( bcva ) was 1.2 with 8.0 sphere and 0.5 with 8.0 sphere in the right and left eyes , respectively .
funduscopy showed a mild staphyloma with some pigmentary changes in the fovea in both eyes ( figure 1a and 1b ) .
fluorescein angiography ( hra2 ; heidelberg engineering gmbh , heidelberg , germany ) showed hyperfluorescence in the fovea in both eyes resulting from a retinal pigment epithelium defect , but there was no leakage point ( figure 1c and 1d ) .
indocyanine green angiography ( hra2 ; heidelberg engineering ) in both eyes revealed punctuate hyperfluorescence in the fovea with no vascular hyperpermeability ( figure 1e and 1f ) .
sd - oct ( cirrus hd - oct ; carl zeiss meditec ag , jena , germany ) in both eyes showed an anterior bulge of the macula with sfd in the horizontal scan ( figure 2a and 2b ) .
the diagnosis of dsm with sfd was made on the basis of characteristic findings from previous studies.13 no treatment was initiated .
three months later , sfd seen at the initial visit disappeared on sd - oct ( figure 2c and 2f ) , and the patient s bcva was 1.2 and 1.0 in the right and left eyes , respectively .
one month later , there was an occurrence of sfd in the right eye ( figure 2 g and 2h ) , although subjective visual worsening was not reported .
one month later , the sfd had disappeared ( figure 2i and 2j ) , and the patient s bcva was 0.9 in the right eye .
to our knowledge , this is the first report of the spontaneous resolution of sfd in dsm , based on a medline ( us national library of medicine , bethesda , md , usa ) search of the english literature available on this subject . in this case ,
sd - oct provided a definite diagnosis of dsm with sfd and permitted documentation of the spontaneous resolution of sfd in dsm .
similar spontaneous resolution was noted in cases with idiopathic central serous chorioretinopathy , and angiography and oct enable differentiation from idiopathic central serous chorioretinopathy .
in particular , punctuate hyperfluorescence with no vascular hyperpermeability on indocyanine green angiography , and an abnormal convex profile with no choroidal thickening on sd - oct , may be important findings in dsm with sfd.1 regarding the pathophysiology of dsm with sfd , imamura et al3 suggested that severe obstruction in the outflow of choroidal fluid might be associated with the characteristic findings of dsm , while byeon and chu5 proposed that compressive changes of the choroid and choriocapillaris , as well as the resultant secondary retinal pigment epithelium changes , may be involved in the pathophysiology of dsm .
the sd - oct images in our patient clearly showed shallow sfd in the parafovea and foveal center in the right and left eyes , respectively . in this case , a conservative observation was used , although left visual acuity was poor .
use of antivascular endothelial growth factor therapy , photodynamic therapy , and focal laser treatment have been described in other cases , but none of these approaches were effective.4 this suggests that choroidal neovascularization and choroidal vascular hyperpermeability are not associated with the pathophysiology of dsm with sfd . in conclusion , the patient in this case had dsm with sfd , which showed spontaneous recovery without treatment .
this case illustrates the utility of sd - oct for the detection and follow - up of dsm with sfd .
dome - shaped macula ( dsm ) was described by gaucher et al as a convex protrusion of macula within a staphyloma in highly myopic eyes that causes visual impairment associated with serous foveal detachment ( sfd ) . 
 we describe a patient with spontaneous resolution of sfd in dsm documented by serial spectral domain optical coherence tomography ( sd - oct ) . 
 a 28-year - old female japanese patient presented with blurred vision in both eyes . upon examination , 
 her best - corrected visual acuity was 1.2 with 8.0 sphere and 0.5 with 8.0 sphere in the right and left eyes , respectively . 
 sd - oct in both eyes showed an anterior bulge of the macula with sfd . 
 the diagnosis of dsm with sfd was made on the basis of characteristic findings . 
 three months later , the patient achieved spontaneous resolution of sfd without treatment . 
 one month later , there was an occurrence of sfd in the right eye , but the sfd had disappeared in 1 month . in our case , 
 her visual impairment was proven to be a consequence of sfd in relation to dsm . 
 sd - oct was useful for the detection and follow - up of sfd in dsm .