Abstract
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.