Progressive development of dome-shaped macula and subsequent onset of punctate inner choroidopathy in a highly myopic patient: a 7-year follow-up case report

Purpose To describe the development of dome-shaped macula (DSM) in a highly myopic patient, followed by the subsequent onset of punctate inner choroidopathy (PIC). Observations A 46-year-old man with high myopia, with a systemic history of psoriatic arthritis and an ocular history of Acanthamoeba keratitis resulted in two penetrating keratoplasties (PK) in his right eye, was followed up regularly at our center for a 7-year period. During the follow-up, the left eye remained stable until the fifth year. However, at the seventh year, a routine fundus examination revealed the asymptomatic appearance of lacquer cracks, which had been absent at baseline. Multimodal imaging evaluation further identified the incidental development of a horizontal oriented DSM and active and inactive PIC foci localized near the newly detected lacquer cracks. Conclusions and importance This case report provides new insights into the formation of DSM, supporting the hypothesis that macular bulge may result from differential elongation of the peri-dome region. Additionally, it highlights that DSM can coexist with PIC.