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  • Title: Morphologic choroidal and scleral changes at the macula in tilted disc syndrome with staphyloma using optical coherence tomography.
    Author: Maruko I, Iida T, Sugano Y, Oyamada H, Sekiryu T.
    Journal: Invest Ophthalmol Vis Sci; 2011 Nov 11; 52(12):8763-8. PubMed ID: 21989725.
    Abstract:
    PURPOSE: To evaluate the macular choroidal and scleral changes in tilted disc syndrome (TDS) with staphyloma using optical coherence tomography (OCT) to determine the mechanism of serous retinal detachment (SRD) formation. METHODS: All eyes underwent fluorescein (FA) and indocyanine green angiography (ICGA) in this retrospective, observational study. Enhanced-depth imaging (EDI) OCT and prototype high-penetration (HP) OCT were used to examine the choroid and sclera, respectively, at the upper and lower optical areas and the subfovea on vertical OCT sections. RESULTS: Twenty-four eyes with TDS with inferior staphyloma were included. FA showed the macular area with the superior edge of staphyloma had a granular hyperfluorescent pattern and ICGA showed belt-like hypofluorescence. OCT showed SRDs in seven eyes. The mean EDI-OCT choroidal thicknesses in 19 eyes were: upper area, 211 ± 79 μm; subfovea, 153 ± 70 μm; and lower area, 158 ± 42 μm. The mean subfoveal and lower choroid were significantly (P < 0.01 for both) thinner than the upper area. The mean HP-OCT scleral thicknesses in 14 eyes were: upper area, 414 ± 36 μm; subfovea, 493 ± 40 μm; and lower area, 398 ± 83 μm. The subfoveal sclera was significantly (P < 0.01) thicker than the others. CONCLUSIONS: The subfoveal choroid was relatively thin and the subfoveal sclera thickened in TDS with a staphyloma edge at the macula. The area with retinal pigment epithelial (RPE) atrophy was hyperfluorescent on FA; choriocapillaris occlusion was hypofluorescent on ICGA. Characteristic anatomic subfoveal scleral alterations might lead to a thinner choroid and inhibit chorioscleral outflow; a secondary RPE disorder subsequently could cause SRDs.
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