Prepapillary vascular loops - A new classification.

Background: Prepapillary vascular loops are a type of congenital vascular anomaly seen on or around the optic disk. Patients with this condition are usually asymptomatic and are detected incidentally on routine fundus examinations. Differential diagnosis for this condition includes neovascularization of the disk and collaterals on the disk. Prepapillary capillary loops are not associated with any systemic condition. They are usually unilateral in presentation, but can rarely be bilateral. Purpose: To discuss the new proposed classification of prepapillary capillary loops. Synopsis: : Prepapillary capillary loops are classified based on their location around the disk, loop characteristics such as elevation, shape, and covering, and presence of vitreoretinal traction. Highlights: The most common vascular loops are arterial in origin and rarely venous in origin. They can sometimes be associated with spontaneous and recurrent vitreous hemorrhage, branch retinal artery or vein occlusion, and subretinal hemorrhage. It is an important differential diagnosis in spontaneous vitreous hemorrhage. Treatment is symptomatic. Video link: : https://youtu.be/gbq_oP7Y2q4.

Frequency of prepapillary vascular loops in Congolese patients.

PURPOSE: To determine the frequency of prepapillary vascular loops in the population of Congolese patients. METHODS: We performed a retrospective cross-sectional and descriptive analysis of the data collected between January 2005 and August 2014 from patients diagnosed with prepapillary vascular loops, in an outpatient eye clinic, a general ophthalmology practice. RESULTS: Out of 16,016 patients seen during the study period, 24 patients (27 eyes) were diagnosed with prepapillary vascular loops, for a frequency of 0.15%. The mean age of the patients with prepapillary vascular loops was 37.8 years±14 (SD) (range, 18 to 60 years). Male were more frequently diagnosed with prepapillary vascular loops than female (62.5% vs 37.5%). Unilateral prepapillary vascular loops were found in 77.8% and bilateral in 22.2% of eyes. Most of PPLs were estimated to be arterial (88.9% of eyes) based on clinical observation alone, as fluorescein angiography was not systematically performed. Ophthalmoscopically, the vessels appeared as simple (44.6%) or took more serial turns (corkscew or spiral-shaped) (55.6%). The average length of PPLs was 1.02mm (range 0.6 to 1.5mm) with an orientation (an axis orientation) in the superior nasal sector (50%), inferior nasal sector (33%) and superior temporal sector (17%); and a mean axis of 143° relative to the horizontal. Refractive errors were found in 16 eyes (59.3%) and included simple myopia (4 eyes, 14.8%), myopic astigmatism (8 eyes, 29.6%), hyperopic astigmatism (one eye, 3.7%), hyperopia (3 eyes, 11.1%); One patient (one eye, 3.7%) with high hyperopia had anisometropia. Primary open angle glaucoma was found in 5 (18.5%) eyes; vascular tortuosity was seen in two (7.4%) eyes. No complication such as retinal arterial occlusion, vitreous hemorrhage, or any other complication was found. CONCLUSION: The frequency of 0.15% found in this study suggests that although rare, prepapillary vascular loops seem to be a bit more common in black people than in white and Asian people. An association between PPLs and refractive errors may be possible.

Prepapillary Vascular Loops Associated with Retinal Diseases

PURPOSE: Prepapillary vascular loops are blood vessels that project from the optic disc into the vitreous cavity and then return to the disc to continue their natural cource. Ninety percent are arterial in origin and usually congenital anomaly. We report four cases of prepapillary vascular loops associated with retinal and choroidal disorders. METHODS: Prepapillary vascular channel which showed twisted or ringlike appearance without leakage on fluorescein angiogram constituted the diagnosis. However, there may be a sector delay in filling of the optic disc or retina supplied by the loop due to the increased distance that blood must travel through the loop. RESULTS: These cases are not associated with vision-threatening diseases. The associated retinal diseases are diabetic retinopathy in one case, retinitis pigmentosa in one case, contralateral posterior uveitis in two cases. They are arterial loops. In two eyes were observed multiple prepapillary vascular loops. The vessels may appear as simple hairpin loops, spiral, or corkscrew configuration. In our cases, the presence of a cilioretinal artery and retinal artery obstruction could not be determined; other complication associated with prepapillary vascular loops were not observed. CONCLUSIONS: We assume that prepapillary vascular loops may occur acquiredly associated with other ocular diseases.