Membrana neovascular yuxtapapilar asociada a drusas del nervio óptico / Juxtapapillary neovascular membrane associated with optic nerve drusen

CASO CLÍNICO: Paciente de 14 años de edad concurre refiriendo una disminución progresiva de la agudeza visual del ojo izquierdo de 3 meses de evolución. Al examen presenta drusas de papila bilateral, asociadas a membrana neovascular yuxtapapilar, que comprometen seriamente la visión y el campo visual del ojo izquierdo. RESULTADO: El tratamiento con 3 inyecciones consecutivas de ranibizumab intravítreo resultó en la inactivación de la membrana neovascular con reabsorción de líquido subretiniano y mejora de la agudeza visual mejor corregida del ojo izquierdo. Después de 9 meses de seguimiento, esta fue 20/20 y estable. CONCLUSIÓN: Si bien las drusas de la cabeza del nervio óptico son consideradas benignas, las membranas neovasculares pueden ser una complicación. Los anti-VEGF son una alternativa eficaz para el tratamiento

CLINICAL CASE: Forteen year old patient presenting progressive decrease in visual acuity of the left eye after 3 months of evolution. On examination he presents bilateral drusen of papilla, associated with juxtapapillary neovascular membrane, which seriously compromises the vision and visual field of the left eye. RESULT: Treatment with 3 consecutive injections of intravitreal ranibizumab resulted in the inactivation of the neovascular membrane with reabsorption of subretinal fluid and improvement of the best corrected visual acuity of the left eye. After 9 months of follow-up, it was 20/20 and stable. CONCLUSION: Although optic nerve head drusen are considered benign, neovascular membranes can be a complication. Anti-VEGFs are an effective alternative for treatment

Juxtapapillary neovascular membrane associated with optic nerve drusen. / Membrana neovascular yuxtapapilar asociada a drusas del nervio óptico.

CLINICAL CASE: Forteen year old patient presenting progressive decrease in visual acuity of the left eye after 3 months of evolution. On examination he presents bilateral drusen of papilla, associated with juxtapapillary neovascular membrane, which seriously compromises the vision and visual field of the left eye. RESULT: Treatment with 3 consecutive injections of intravitreal ranibizumab resulted in the inactivation of the neovascular membrane with reabsorption of subretinal fluid and improvement of the best corrected visual acuity of the left eye. After 9 months of follow-up, it was 20/20 and stable. CONCLUSION: Although optic nerve head drusen are considered benign, neovascular membranes can be a complication. Anti-VEGFs are an effective alternative for treatment.

Clinical particularities in an atypical case of retinitis pigmentosa.

We present a case of Retinitis Pigmentosa with atypical aspect of fundus (Punctata Albescens), associated with Cystoid Macular Oedema and Optic Disc Drusen.

[Bilateral Macular Edema Caused by Optic Disc Drusen - a Case Report]. / Bilaterální makulární edém na podklade drúzových papil.

UNLABELLED: In the case report, bilateral cystoid macular edema with optic disc edema on the left side in young man is described. As etiology out of the systemic diseases, we considered the hypertension. The results of the neurological examination, including the brain CT examination were physiological. The patient was examined by the internal specialist, the hypertension was treated - and it was the presumed etiology of the ophthalmologic findings. Due to the repeated worsening of the ophthalmologic findings, we searched for other etiology. Bilateral buried optic disc drusen were found by means of ultrasound. Bilateral cystoid macular edema and optic disc edema were evaluated as signs of circulatory disturbance of the posterior ciliary arteries and macular choroid caused by optic disc drusen. The antiglaucomatic treatment was started with - alpha 2 adrenergic receptors agonist - brimonidine - which increases the blood supply of the optic nerve and decreases the intraocular pressure with presumed delay of axons dysfunction. KEY WORDS: macular edema, optic disc drusen, intraocular pressure, visual field, ultrasound.

Efficacy of topical dorzolamide therapy for cystoid macular edema in a patient with MFRP-related nanophthalmos-retinitis pigmentosa-foveoschisis-optic disk drusen syndrome.

PURPOSE: Mutations in the MFRP (membrane-type frizzled-related protein) gene leads to an entity characterized by retinitis pigmentosa, nanophthalmos, optic disk drusen, and macular changes, originally described as foveoschisis. Despite the association of MFRP gene mutation and increase in macular thickness, no treatment modality has been described for cystoid macular edema related to this particular entity so far. METHODS: In this case report, a 52-year-old woman presented with nanophthalmos, optic disk drusen, retinitis pigmentosa, and increase in macular thickness. Genetic analysis revealed an MFRP gene mutation. The patient was treated with topical carbonic anhydrase inhibitors. RESULTS: A progressive decrease in macular thickness and cystic changes was observed during the 2-month course of topical carbonic anhydrase inhibitor treatment, and best-corrected visual acuity improved from 20/100 to 20/50. Macular thickness remained stable after 6 months of follow-up. CONCLUSION: Cystoid macular edema is part of the macular changes noted in the MFRP mutation-related nanophthalmos-retinitis pigmentosa-foveoschisis-optic disk drusen, syndrome. Taking into account that resolution of cystoid macular edema in patients with retinitis pigmentosa may delay an irreversible decrease in visual acuity, treatment should be considered when cystic changes are suspected. Topical carbonic anhydrase inhibitor was effective in decreasing macular thickness and cystic changes in the patient reported.

Unilateral extrafoveal choroidal . ......... eovascularization in a 13-year-old child with bilateral optic nerve drusen.

AIM: The aim of our research was to describe the effect of an off-label intravitreal ranibizumab injection for treatment of unilateral extrafoveal choroidal neovascularization a with bilateral optic nerve drusen. MATERIAL AND METHODS: 13-year-old girl presented with decreased visual acuity of her left eye and optic nerve drusen confirmed by B-scan ultrasound examination in both eyes. Fluorescein angiography and optical coherence tomography revealed the presence of choroidal neovascularization in the left eye. The patient was treated with a single injection of ranibizumab and monitored by clinical examination, optical coherence tomography and fluorescein angiography. RESULTS: Choroidal neovascularization was successfully treated and the best corrected visual acuity (Snellen) fully recovered from 20/50 to 20/20 over a period of 2 months. After this time at the 30 months follow-up, visual acuity and fundus were stable without the recurrence of choroidal neovascularization. CONCLUSIONS: Optic nerve drusen should be taken into account and carefully observed as a possible cause of peripapillary choroidal neovascularization in children. Ranibizumab can be a successful off-label treatment in children suffering from choroidal neovascularization associated with optic nerve drusen.

[The diagnostic risk of overlooking temporal arteritis]. / Vom Risiko, die Diagnose einer Arteriitis temporalis zu versäumen.

We report two cases of atypical temporal arteritis. A 73-year-old woman with typical internal (diabetes, hypertony, hypercholesterinemia) and ophthomological (optic disc drusen) risk factors for N-AION reported with an acute unilateral decrease in vision. General symptoms, laboratory analysis and biopsy led to the diagnosis of temporal arteritis and iv steroids were administered. An 83-year-old male patient reported with a sudden unilateral decrease in vision, but did not complain about general symptoms. Laboratory analysis revealed no signs for temporal arteritis, therefore the patient was referred to his internal specialist for evaluation of internal risk factors for N-AION. A few days later the patient reported with a unilateral decrease in vision of the partner eye. This time blood analysis was suggestive of temporal arteritis although no general symptoms were reported. Diagnosis was supported by a biopsy of the temporal artery and steroids were administered. These two cases teach us how dangerously easy temporal arteritis can be overlooked and that we have to take even the slightest hint for temporal arteritis seriously and initiate treatment as early as possible.

[Optic nerve disc drusen]. / Drusen al papilei nervului optic.

Optic nerve head drusen represents a frequent condition, with unknown pathogenesis, mostly asymptomatic. Here, we present a patient with visual impairment, who has reacted well to anti-inflammatory and vasodilator treatment.

Bilateral CNV associated with optic nerve drusen treated with photodynamic therapy with verteporfin.

PURPOSE: To report a case of bilateral choroidal neovascularization (CNV) associated with optic nerve drusen (OND) treated with photodynamic therapy (PDT) with verteporfin. METHODS: A 10-year-old girl with juxtapapillary CNV in the right eye and juxtapapillary and juxtafoveal CNV in the left eye associated with OND underwent PDT with verteporfin in both eyes. RESULTS: Visual acuity increased from 20/160 to 20/25 in the right eye and from 20/1000 to 20/25 in the left eye after two sessions of PDT and 2 years of follow-up. CNV showed no leakage after two PDT sessions in both eyes and no recurrence was observed. CONCLUSIONS: Subfoveal CNV is an uncommon complication of OND and excellent anatomic and functional results can be obtained with PDT.