AuthorPradeep Sagar, MD

Purpose: To describe the clinical features and optical coherence tomography (OCT) features of ‘abnormal macular contour associated (AMAC) maculopathy’. The term ‘AMAC maculopathy’ was used to include disorders with abnormal macular contour including dome shaped macula (DSM), tilted disc syndrome (TDS) and other cases (non specific) which are not previously described as distinct entities.

Methods: This is a retrospective series of 46 eyes with abnormal macular contour. Fundus photograph and OCT were captured with Topcon DRI OCT Triton. Fundus fluorescein angiography and indocyanine green angiography were performed in selected cases.

Results: Of all the 46 eyes with abnormal macular contour, 6 (13.04%) eyes were DSM, 17 (36.95%) eyes were TDS. 23 (50%) eyes had abnormal macular contour but were not typical of either DSM or TDS. Choroidal thickness was significantly higher in areas with elevation than in areas with excavation. Large choroidal vessels with attenuation of overlying choriocapillaries suggestive of pachychoroid was seen 80.43% of cases. Retinal pigment epithelial (RPE) irregularity and shallow pigment epithelial detachment was seen in 50% of eyes. 17.39% of eyes had subretinal fluid (SRF). 4.34% of eyes had clinical features and angiographic features suggestive of acute central serous chorioretinopathy (CSCR). All the cases with RPE irregularity, SRF had pachychoroid.

Conclusion: Considering the presence of similar choroidal and RPE characteristics on OCT, the disorders with abnormal macular contour including DSM, TDS and the non specific cases described in this series can be grouped as ACAM maculopathy. Considering the presence of pachychoroid in all cases with maculopathy, ACAM maculopathy could be considered a part of pachychoroid spectrum of diseases.