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

To describe the development of dome-shaped macula (DSM) in a highly myopic patient, followed by the subsequent onset of punctate inner choroidopathy (PIC). 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. 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. • Differential elongation of the eye, particularly in the peri-dome region, contributes to the development of macular bulge in dome-shaped macula (DSM). • DSM may be associated with punctate inner choroidopathy. • Inflammatory lesions align differently with the orientation of the macular bulge. Claim of priority : To the best of our knowledge, no previous reports have demonstrated the development of DSM over time. A literature review using keywords "Dome-shaped macula" and "punctate inner choroidopathy" in PubMed and Google Scholar (as of February 25, 2025) did not yield any prior reports.