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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

B-scan (low gain) of the right optic disc showing moderately high reflectivity consistent with surface ODD (arrow).
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fig4: B-scan (low gain) of the right optic disc showing moderately high reflectivity consistent with surface ODD (arrow).

Mentions: In view of CRVO, investigations for vascular risk factors were performed which showed a blood pressure of 130/80 mmHg, fasting blood glucose level of 5.4 mmol/L, and hypercholesterolaemia. Fluorescein angiography (FA) demonstrated blocked fluorescence over the area of the subretinal hemorrhage but no capillary fallout or leakage (Figure 2). Indocyanine green angiography (ICGA) did not reveal any hyperfluorescent hot spots suggestive of PCV (Figure 3). B-scan ultrasound revealed moderately high reflectivity over the elevated optic disc consistent with surface ODD (Figure 4). A diagnosis of right ODD with simultaneous complications of peripapillary subretinal hemorrhage and CRVO from direct mechanical compression of peripapillary and retinal vessels was made. In the absence of CNV, PCV, and macular oedema as well as preservation of good BCVA, he was managed conservatively with close observation. Follow-up at 2 months after presentation showed spontaneous resolution of his right optic disc swelling, subretinal hemorrhages, and CRVO (Figure 1(b)).


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)

B-scan (low gain) of the right optic disc showing moderately high reflectivity consistent with surface ODD (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig4: B-scan (low gain) of the right optic disc showing moderately high reflectivity consistent with surface ODD (arrow).
Mentions: In view of CRVO, investigations for vascular risk factors were performed which showed a blood pressure of 130/80 mmHg, fasting blood glucose level of 5.4 mmol/L, and hypercholesterolaemia. Fluorescein angiography (FA) demonstrated blocked fluorescence over the area of the subretinal hemorrhage but no capillary fallout or leakage (Figure 2). Indocyanine green angiography (ICGA) did not reveal any hyperfluorescent hot spots suggestive of PCV (Figure 3). B-scan ultrasound revealed moderately high reflectivity over the elevated optic disc consistent with surface ODD (Figure 4). A diagnosis of right ODD with simultaneous complications of peripapillary subretinal hemorrhage and CRVO from direct mechanical compression of peripapillary and retinal vessels was made. In the absence of CNV, PCV, and macular oedema as well as preservation of good BCVA, he was managed conservatively with close observation. Follow-up at 2 months after presentation showed spontaneous resolution of his right optic disc swelling, subretinal hemorrhages, and CRVO (Figure 1(b)).

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