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Case report of optic disc drusen with simultaneous peripapillary subretinal hemorrhage and central retinal vein occlusion.

Law DZ, Yang FP, Teoh SC - Case Rep Ophthalmol Med (2014)

Bottom Line: Fundus fluorescein (FA) and indocyanine green angiographies (ICGA) of the right eye did not demonstrate choroidal neovascularization (CNV), polypoidal choroidal vasculopathy (PCV), or retinal ischemia.Mechanical impairment of peripapillary circulation also results in retinal ischemia and may trigger the development of choroidal neovascularization (CNV) and/or polypoidal choroidal vasculopathy (PCV), leading to subretinal haemorrhage.Compromise in central venous outflow with increased retinal central venous pressure from the direct mechanical effects of enlarging ODD results in central retinal vein occlusion (CRVO).

View Article: PubMed Central - PubMed

Affiliation: National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433 ; Vision Performance Centre, Military Medicine Institute, Singapore Armed Forces, Block 27 Medical Drive, DSO Building Lower Kent Ridge Road, Singapore 117510.

ABSTRACT
A 52-year-old Chinese gentleman presented with right eye floaters and photopsia over one week. His visual acuities were 20/20 bilaterally. Posterior segment examination showed a right eye swollen optic disc and central retinal vein occlusion (CRVO) associated with an area of subretinal hemorrhage adjacent to the optic disc. Fundus fluorescein (FA) and indocyanine green angiographies (ICGA) of the right eye did not demonstrate choroidal neovascularization (CNV), polypoidal choroidal vasculopathy (PCV), or retinal ischemia. Ultrasound B-scan revealed optic disc drusen (ODD). In view of good vision and absence of CNV, he was managed conservatively with spontaneous resolution after two months. Commonly, ODD may directly compress and mechanically rupture subretinal vessels at the optic disc, resulting in peripapillary subretinal hemorrhage, as was likely the case in our patient. Mechanical impairment of peripapillary circulation also results in retinal ischemia and may trigger the development of choroidal neovascularization (CNV) and/or polypoidal choroidal vasculopathy (PCV), leading to subretinal haemorrhage. Compromise in central venous outflow with increased retinal central venous pressure from the direct mechanical effects of enlarging ODD results in central retinal vein occlusion (CRVO). Patients with subretinal hemorrhage and CRVO from ODD should be monitored closely for the development of potentially sight-threatening complications.

No MeSH data available.


Related in: MedlinePlus

(a) Intraretinal hemorrhages over a right swollen optic disc associated with peripapillary hemorrhages, an area of subretinal hemorrhage inferonasally and venous tortuosity consistent with CRVO. (b) Spontaneous resolution of right optic disc swelling, peripapillary subretinal hemorrhage, and CRVO after two months.
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fig1: (a) Intraretinal hemorrhages over a right swollen optic disc associated with peripapillary hemorrhages, an area of subretinal hemorrhage inferonasally and venous tortuosity consistent with CRVO. (b) Spontaneous resolution of right optic disc swelling, peripapillary subretinal hemorrhage, and CRVO after two months.

Mentions: His best-corrected visual acuities (BCVA) were 20/20 OU with intraocular pressures of 15 mmHg bilaterally on Goldmann applanation tonometry (GAT) and no relative afferent pupillary defect (RAPD). Anterior segment examinations were unremarkable. Posterior segment examination showed right optic disc swelling which was more pronounced nasally, flame-shaped optic disc hemorrhages, venous tortuosity, and extensive flame hemorrhages without vasculitis, consistent with CRVO. Although the Disc-Macula/Disc-Disc (DM/DD) ratio on fundal photography was measured to be 2.44 (normal) and nonindicative of optic disc anomalies for example, small optic discs associated with optic nerve hypoplasia (ONH), there was marked filling of the physiological cup. In addition, there was an area of subretinal hemorrhage of 1.5 disc-diameter inferonasal to the optic disc (Figure 1(a)). Fundal examination of the left eye was normal.


Case report of optic disc drusen with simultaneous peripapillary subretinal hemorrhage and central retinal vein occlusion.

Law DZ, Yang FP, Teoh SC - Case Rep Ophthalmol Med (2014)

(a) Intraretinal hemorrhages over a right swollen optic disc associated with peripapillary hemorrhages, an area of subretinal hemorrhage inferonasally and venous tortuosity consistent with CRVO. (b) Spontaneous resolution of right optic disc swelling, peripapillary subretinal hemorrhage, and CRVO after two months.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4269277&req=5

fig1: (a) Intraretinal hemorrhages over a right swollen optic disc associated with peripapillary hemorrhages, an area of subretinal hemorrhage inferonasally and venous tortuosity consistent with CRVO. (b) Spontaneous resolution of right optic disc swelling, peripapillary subretinal hemorrhage, and CRVO after two months.
Mentions: His best-corrected visual acuities (BCVA) were 20/20 OU with intraocular pressures of 15 mmHg bilaterally on Goldmann applanation tonometry (GAT) and no relative afferent pupillary defect (RAPD). Anterior segment examinations were unremarkable. Posterior segment examination showed right optic disc swelling which was more pronounced nasally, flame-shaped optic disc hemorrhages, venous tortuosity, and extensive flame hemorrhages without vasculitis, consistent with CRVO. Although the Disc-Macula/Disc-Disc (DM/DD) ratio on fundal photography was measured to be 2.44 (normal) and nonindicative of optic disc anomalies for example, small optic discs associated with optic nerve hypoplasia (ONH), there was marked filling of the physiological cup. In addition, there was an area of subretinal hemorrhage of 1.5 disc-diameter inferonasal to the optic disc (Figure 1(a)). Fundal examination of the left eye was normal.

Bottom Line: Fundus fluorescein (FA) and indocyanine green angiographies (ICGA) of the right eye did not demonstrate choroidal neovascularization (CNV), polypoidal choroidal vasculopathy (PCV), or retinal ischemia.Mechanical impairment of peripapillary circulation also results in retinal ischemia and may trigger the development of choroidal neovascularization (CNV) and/or polypoidal choroidal vasculopathy (PCV), leading to subretinal haemorrhage.Compromise in central venous outflow with increased retinal central venous pressure from the direct mechanical effects of enlarging ODD results in central retinal vein occlusion (CRVO).

View Article: PubMed Central - PubMed

Affiliation: National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433 ; Vision Performance Centre, Military Medicine Institute, Singapore Armed Forces, Block 27 Medical Drive, DSO Building Lower Kent Ridge Road, Singapore 117510.

ABSTRACT
A 52-year-old Chinese gentleman presented with right eye floaters and photopsia over one week. His visual acuities were 20/20 bilaterally. Posterior segment examination showed a right eye swollen optic disc and central retinal vein occlusion (CRVO) associated with an area of subretinal hemorrhage adjacent to the optic disc. Fundus fluorescein (FA) and indocyanine green angiographies (ICGA) of the right eye did not demonstrate choroidal neovascularization (CNV), polypoidal choroidal vasculopathy (PCV), or retinal ischemia. Ultrasound B-scan revealed optic disc drusen (ODD). In view of good vision and absence of CNV, he was managed conservatively with spontaneous resolution after two months. Commonly, ODD may directly compress and mechanically rupture subretinal vessels at the optic disc, resulting in peripapillary subretinal hemorrhage, as was likely the case in our patient. Mechanical impairment of peripapillary circulation also results in retinal ischemia and may trigger the development of choroidal neovascularization (CNV) and/or polypoidal choroidal vasculopathy (PCV), leading to subretinal haemorrhage. Compromise in central venous outflow with increased retinal central venous pressure from the direct mechanical effects of enlarging ODD results in central retinal vein occlusion (CRVO). Patients with subretinal hemorrhage and CRVO from ODD should be monitored closely for the development of potentially sight-threatening complications.

No MeSH data available.


Related in: MedlinePlus