Title

OPTIC NERVE HEAD DRUSEN CAUSING CENTRAL RETINAL VEIN OCCLUSION CASE REPORT

Introduction

Optic nerve head drusen (ONHD) are usually calcified globular bodies located within the substance of the optic nerve head. They are present in up to 2% of the population and are often bilateral (75%). They can be associated with retinitis pigmentosa and angioid streaks. Symptoms are usually absent, but some patients may experience episodic blurring, possibly due to transient ischemia related to a crowding effect.

Methods

Medical record review.

Results

A 75-year-old woman presented with a 1-year history of painless and sudden loss of vision in the right eye (OD). Her best corrected visual acuity (BCVA) was 20/600 / 20/40. She denied diabetes and hypertension. OD fundus examination revealed an elevated optic nerve head with multi-lobular yellowish-white nodules and vascular tortuosity. In the left eye (OS), fundoscopy showed a crowded disc. B-mode US revealed a hyperechogenic appearance. FAF showed oval hyperautofluorescent areas in the optic discs. Fluorescein Angiography detected extensive areas of capillary non-perfusion and macular hyperfluorescence. Scattered laser spots could also be seen in the OD. The patient had previously undergone pan-photocoagulation treatment elsewhere. An aspect of disc head swelling was present on the OCT of the OD. On the macular OCT of the a cystoid macular edema was observed. Our diagnostic hypothesis was bilateral ONHD causing a secondary CRVO in this patient’s OD. The patient is being currently treated with intra-vitreous anti-VEGF injections.

Discussion

The anatomical changes caused by ONHD may alone increase the risk of CRVO. The presence of drusen alters the flow dynamics of the central retinal vein by altering the path and potentially constricting the vascular diameter. There is no proven treatment for ONHD. The management of vascular complications, such as CRVO, is similar to the management of these disorders in the absence of drusen.

Keywords

optic disc drusen, CRVO, complication, complementary exams, fundoscopy, OCT, angiofluoresceinography, autofluor

Area

CLINICAL CASE

Authors

Rafael Garcia, Walther de Oliveira Campos Neto, Carolina Maria Barbosa Lemos, Paulo Henrique Horizonte, Raimunda Cristina Mendonça Freire de Oliveira, Henrique Monteiro Leber, Leonardo de Angelli Benedito Cardoso, André Marcelo Vieira Gomes