Histologic findings after surgical excision of optic nerve head drusen

PURPOSE: To report the histopathologic findings of a case of bilateral massive optic nerve head (ONH) drusen. METHODS: A 59-year-old man presented with bilateral massive ONH drusen and secondary compromise of the retinal vasculature leading to vision of counting fingers at 1 ft in the left eye and 20/30 in the right eye. The inferior one half of the left ONH druse was excised resulting in no light perception vision postoperatively. RESULTS: Energy-dispersive spectroscopy suggested the composition of the ONH druse to be calcium phosphate (Ca3[PO4]2), which has implications on pathogenesis of neuronal cell death in ONH drusen. Scanning electron microscopy demonstrated embedded metal particles, likely to be remnants of the instruments used. CONCLUSION: Massive ONH drusen are actually one large druse that has multiple excrescences on its surface giving it the variegated appearance. Although surgical excision of ONH drusen may be technically possible, consideration should be given to improvements in instrumentation and patient selection criteria.     

Hemorrhagic complications of optic nerve drusen

We found hemorrhages in 13 eyes of 57 patients with optic disk drusen. In seven eyes, the hemorrhages originated in peripapillary choroidal neovascular membranes. In the other six eyes, no neovascular membrane was present. Hemorrhages that occurred in the absence of choroidal new vessels caused no visual symptoms in any patient. All resolved without sequelae. Hemorrhages originating in choroidal neovascular membranes commonly caused visual symptoms; however, six of seven eyes retained visual acuities of 6/12 (20/40) or better without any therapy. Thus, despite potential submacular hemorrhage, we do not recommend routine photocoagulation for peripapillary choroidal neovascular membranes secondary to optic disk drusen.     

Perimetric aspects in optic nerve drusen

The drusen of the optic nerve head is a relative rare occurrence in ophthalmologic practice, but it induce more or less important functional alterations. In this issue we present some characteristics of visual field impairment present at the patients with drusen of optic nerve head.     

Pulfrich's phenomenon and drusen of optic nerve head

The comportment of placing a swinging pendulum (Pulfrich's phenomenon) in front of three cases of optic nerve head drusen has shown that reduced conductivity is a fact in the optic nerve harboring the drusen, giving oval circular movement. A suggestion is made to use this simple test in patients with this disease.     

Scleral canal size and optic nerve head drusen

From projected optic disk photographs we measured the size of the scleral canal in two samples of emmetropic patients: one of patients with unilateral pseudopapilledema and drusen and the other of the general normal population. Measurements on the non-drusen-containing optic disk of patients with unilateral drusen were taken to reflect the scleral canal size of the fellow, affected eye. For both trained (t = 6.642) and untrained (t = 4.274) observers, the average diameters of the non-drusen-containing optic disks of patients with unilateral drusen were significantly smaller than those of the optic disks of normal patients (P = .0005, one-tailed independent t-test). The association of a small scleral canal with vascular anomalies, frequently noted in optic disks of patients with drusen, indicates a mesodermal dysgenesis of the optic nerve head.     

Acute anterior ischemic optic neuropathy in association with optic nerve drusen

The authors present a case of 31 years old male, with superficial optic disc drusen, complicated with acute anterior ischemic optic neuropathy. The diagnosis was specified clinically, by fluorescein angiography, and by ultrasonography. The disease, very rare cited in the literature, is characteristic for the young adult and has a good prognosis. The unknown pathogeny gives an important place to the compression of the nervous fibres/ciliary circulation by the optic disc drusen, in a limited space and with a high density of optic fibres.     

Two differing presentations of optic nerve head drusen.

BACKGROUND: Optic nerve head drusen was recognized histologically in 1858 by Heinrich Muller The majority of optic nerve head drusen cases have been benign in nature. However, optic nerve head drusen can be visually devastating. CASE REPORTS: Two patients were diagnosed with optic nerve head drusen. They were similar in age and each had a best-corrected visual acuity of 20/20 OU. Although the diagnosis was the same, the disease affected each person very differently. One is currently asymptomatic; the other is legally blind secondary to severely constricted visual fields. These cases demonstrate the diversity of visual effects produced by optic nerve head drusen. Appropriate ocular workup, including visual fields, B-scan ultrasonography, computed tomography, and other tests, are presented. CONCLUSION: There is no existing treatment for optic nerve head drusen. Proper diagnosis and patient education is the best-available modality of care. Patients need to be aware of potential complications which, while rare, can affect vision. Visual-field testing can aid in monitoring for subtle changes in vision.     

Acute anterior ischemic optic neuropathy in the course of optic nerve drusen

Authors present the case of 48 years old male with acute anterior ischemic optic neuropathy (AION) in presence of optic nerve drusen. AION occurred in both eyes, but not at the same time. Diagnosis was made on the basis of laboratory tests, ultrasonographic examination and fluorescein angiography. In the course of treatment improvement of visual acuity was achieved , but concentric constriction of visual field remained. As no effective treatment of non vascular AION was proposed so far, major stress should be put on elimination of its vascular risk factors.     

Pseudopapilledema secondary to optic nerve drusen: ophthalmoscopic differentiation

Two cases of pseudopapilledema secondary to optic nerve drusen were presented. The first case demonstrated the difficulty of ophthalmoscopic differentiation in children and the possible misapplication of invasive neurologic procedures. The second case report demonstrated the relatively greater ease of ophthalmoscopic differentiation in adults and the familial and progressive nature of optic nerve drusen. Also presented were some of the possible sequelae of this condition.     

Difficulties of diagnosis in a case of optic nerve drusen

This paper presents a particullary case of optic nervue drusen. Ophthalmoscopic features (superficial drusen in one eye and deep drusen in another), clinical association with anisometropia and ambliopia, wrong interpretation of PEV and tomodensitometry mod to diagnostic confusion, supplementary investigations, prolonged and expensive treatment.     

Afferent pupillary defect associated with optic nerve head drusen.

BACKGROUND: Optic nerve head drusen (ONHD) are a relatively uncommon finding with an estimated prevalence of anywhere from 0.3% to 2%. Reports of relative afferent pupillary defects (RAPDs) associated with ONHD are scarce. CASE REPORT: A patient with an RAPD was found to have ONHD as the only apparent etiology of the RAPD. The various diagnostic tests relevant to the case, the differential diagnosis, and the pathological features of ONHD are discussed. CONCLUSIONS: It is important for the clinician to consider an RAPD as a possible pathological feature of ONHD--especially with an asymmetric presentation.     

Optic nerve head drusen associated with abnormally small optic discs

Summary Using Littmann's method for correcting the magnification of central fundus photographs we evaluated the absolute optic disc size in 26 eyes with visible optic nerve head drusen. The optic nerve head area in these eyes (1.79 + –0.50mm²) was significantly smaller (p<0.001) than normal standard values previously determined (2.89 + –0.76 mm²). The drusen were most commonly located and most densely packed at the upper and lower optic disc border. The coefficients of variation of the method's reproducibility were 0.06 for intraobserver and 0.11 for interobserver determination.The abnormally small optic disc indicating an abnormally small optic nerve scleral canal may inhibit by mechanical compression the axonal flow within the optic nerve fibers. This may ultimately lead to drusen formation. Pseudoneuritis also associated with an abnormally small optic disc may be a preceder of acquired optic nerve head drusen.This study was supported in part by the Deutsche Forschungsgemeinschaft, grant Nr. NA/55-4/1.     

Submacular surgery for choroidal neovascularization secondary to optic nerve drusen

PURPOSE: To report a case of bilateral choroidal neovascularization (CNV) secondary to optic nerve drusen (OND). DESIGN: Interventional case report. METHODS: A 9-year-old girl presented with peripapillary CNV of the right eye and peripapillary and subfoveal CNV of the left eye secondary to OND. The CNV was excised with submacular surgery in the left eye. RESULTS: Visual acuity increased from 0.05 to 0.3 in the left eye after submacular surgery and did not change from 0.3 in the right eye during 6-month follow-up. Partial retinal pigment epithelial atrophy, but no recurrence of CNV, was observed after CNV excision. CONCLUSION: Subfoveal CNV is an uncommon complication of OND and surgical excision may be useful in selected cases.