Abstract
Purpose :
Optic Nerve Head Drusen (ONHD) are acellular, calcified bodies usually located anterior to the lamina cribosa and are associated with several complications including retinal vascular occlusion, anterior ischemic optic neuropathy, and choroidal neovascular membrane (CNVM). We compared optical coherence tomography angiography (OCT-A) with traditional multimodal imaging in a patient with bilateral optic nerve head drusen, severe visual field loss and central vision sparing.
Methods :
We present a case of a middle-aged male with longstanding visual field loss secondary to bilateral optic nerve head drusen (ONHD) since childhood. His medical history was significant for hypertension and T2DM non-insulin dependent and positive family history of ONHD (M) and DM (F). On examination, the BCVA was 20/20-2 OU with a trace rAPD OD. Biomicroscopy of the anterior segment was unremarkable and ocular pressure was within normal limits OU. Dilated fundus examination revealed extensive optic nerve disc drusen OU and retinal hemorrhages and exudates in the inferonasal macula adjacent to the disc margin. Fundus autofluoresence, fluorescein angiography, OCT and OCT-A were performed.
Results :
The optic disc drusen are striking on both the fundus photos (Fig. 1) and particularly the autofluorescence (Fig. 2). Traditional intravenous angiography methods showed late leakage on fluorescein angiography (inferonasal macula) consistent with a juxtapapillary CNVM OD. Swept Source OCT also nicely illustrated both the juxtapapillary subretinal fluid and optic disc drusen. OCT-A identified a small juxtapapillary choroidal neovascular membrane (CNVM) inferonasal to the macula correlating with the area of retinal hemorrhage and exudates.
Conclusions :
OCT-A imaging allows for precise in vivo localization of the retinal and choroidal vasculatures, including the peripapillary network. Thus, it can be a valuable and noninvasive tool for the detection of ONHD but also for its complications and prognosis.
This abstract was presented at the 2019 ARVO Imaging in the Eye Conference, held in Vancouver, Canada, April 26-27, 2019.