Visual outcomes, incidence and risk factors for RPE atrophy in myopic patients with dome-shaped macula and serous retinal detachment

Objective: To evaluate the visual outcomes, incidence, and risk factors for retinal pigment epithelium (RPE) atrophy in highly myopic patients with dome-shaped macula (DSM) and serous retinal detachment (SRD). Methods: Baseline and follow-up data were analyzed for visual acuity (VA), myopic classification, spherical equivalent (SE), and SRD presence. Incomplete RPE atrophy is characterized by discontinuous hypertransmission (<250 μm) with an irregular or interrupted RPE band. Persistent SRD was defined as fluid present in all follow-up visits. The primary outcome was VA change over time and its predictors. RPE atrophy incidence was estimated using Kaplan–Meier analysis, and risk factors were assessed using univariate Cox regression. Results: Thirty eyes from 23 patients were included, mean age (SD) 53.4 ± 11.7 years, with a mean follow-up of 6.8 (2.7) years. Mean SE (SD) was −9.33 (3.6) diopters. Persistent SRD was observed in 18 (60%) eyes. The baseline VA was 0.34 ± 0.26 logMAR. Eyes with patchy atrophy and incomplete RPE atrophy exhibited worse VA (p < 0.01). VA declined minimally over time (+0.02 logMAR/year; p < 0.001). Discussion: Persistent SRD (p = 0.04) and incomplete RPE atrophy (p < 0.01) were associated with faster visual loss. The incidence rate of incomplete RPE atrophy was low (9/100 eye-years, 95% CI: 2.8–15.4). Younger age (HR = 0.95; p = 0.043) was associated with RPE atrophy progression. Across the follow-up period 5 eyes (17%) developed macular neovascularization (MNV). Conclusions: DSM with SRD is characterized by minimal visual decline and a low risk of incomplete RPE atrophy but can be complicated by MNV. SRD is persistent in most eyes but does not accelerate RPE atrophy.