[Optic Disc Drusen and their Complications]. / Drúzy papily zrakového nervu a jejich komplikace.

UNLABELLED: The aim of the study was to analyze the group of patients with optic disc drusen focusing on possible complications of this disease. MATERIAL AND METHODS: In our group of patients, we examined 46 eyes of 23 patients with the suspicion of optic disc drusen during the period from May 2013 until January 2014. In all adult patients, we examined the anterior and posterior segment of the eye biomicroscopically, established the visual acuity, measured the intraocular pressure, examined the visual field, performed the ultrasound examination of the eye (A and B-scan), analyzed the retinal nerve fiber layer (RNFL) by means of optic coherence tomography (OCT), and color and red-free photography. According to the biomicroscopical findings, the drusen were divided into invisible drusen (buried drusen) (verified by ultrasound only) - grade 0, visible delicate drusen - grade I, and multiple drusen (conglomerates) - grade II. RESULTS: Out of 23 patients, 14 were women and 9 were men. The age of the patients ranged from 8 to 82 years, the mean age was 44.4 years. In the group, there were 3 children (8, 11, and 13 years). In twenty-two patients, the drusen were present bilaterally, and one female patient had drusen on the right eye only. The grade of the drusen was set from 0 to II in all 45 eyes according to their amount, location, and visibility. As grade 0 were evaluated drusen in 11 patients; out of them, 10 patients had drusen bilaterally, and one female patient unilaterally. Out of these 11 patients, three were children. Grade I optic disc drusen bilaterally had nine patients, and three patients had drusen grade II bilaterally. In grade 0 drusen, no defect of the visual field was noticed. In drusen grade I, it was noticed the defect of the visual field in two patients (four eyes) out of nine patients, and in grade II the defect was present in two out of three patients (three eyes). The evaluation of the RNFL, by means of OCT, was performed among all three groups according to their grade 0 - II. In higher grades, the thickness of the RNFL was lower. Comparing to drusen grade 0, the drusen grade I, and II presented serious thinning of the RNFL superiorly. In three patients (drusen grade 0 and I) other complications of the optic disc drusen were observed. In one female patient with drusen grade I, there was decrease of the visual acuity due to the partial intravitreal hemorrhage in her left eye and parapapillary located retinal hemorrhages. In one male patient with drusen grade 0 was bilateral decrease of the VA due to cystoid macular edema caused by drusen. This patient had also retinal hemorrhages located near the papilla and partial intravitreal hemorrhage in his worse left eye. In one female patient with the drusen grade 0, the tortuous veins were noticed. CONCLUSION: Drusen of the optic disc are present in 0.3 - 1.0 % of the population, and are bilateral in approximately 75 - 91 % of the cases. It is important to distinguish optic nerve disc drusen from the papiledema. Drusen of the optic nerve can cause severe defects of the visual field, decrease of the retinal nerve fiber layer, and may be accompanied by vessels complications. Patients with the optic disc drusen should regularly undergo ophthalmologic examinations focused on the intraocular pressure, visual field testing, and retinal fiber layer analysis. In patients with visual field defect and borderline values of intraocular pressure, the antiglaucomatic therapy is recommended. KEY WORDS: optic disc drusen, intraocular pressure, visual field, ultrasound, retinal nerve fiber layer analysis, complications of the optic disc drusen.

Measurement of retinal nerve fiber layer and macular ganglion cell-inner plexiform layer with spectral-domain optical coherence tomography in patients with optic nerve head drusen.

PURPOSE: To evaluate the effect of optic nerve head drusen (ONHD) on the retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GCIPL) using Cirrus optical coherence tomography (OCT). METHODS: Fifty-seven eyes of thirty patients with ONHD and thirty-eight eyes of twenty age-matched and sex-matched control subjects underwent circumpapillary and macular scanning using Cirrus OCT. The percentages of eyes with abnormal GCIPL and RNFL values according to the Cirrus normative data were analysed and compared. RESULTS: Overall, eyes with ONHD showed abnormally reduced values for average and minimum GCIPL thicknesses in 35 % and 45 % of cases compared to 2 % for both values in control eyes (P < 0.001). Average RNFL thickness comparison between eyes with ONHD and normal eyes revealed abnormal thinning in 33 % vs. 0 %, respectively (p = 0.002). The percentage of abnormal thinning increased with higher grades of ONHD for all the parameters evaluated, so that in grade III drusen, values were abnormally reduced in 80 % of eyes in all three analyses. Regarding buried ONHD, 30 % and 4 % of eyes had an abnormally reduced minimum GCIPL and average RNFL thickness, respectively. Furthermore, 26 % of these eyes had abnormal GCIPL exams with a normal or increased RNFL thickness. CONCLUSIONS: Both RNFL and GCIPL analysis reveal significant thinning in eyes with ONHD directly correlated with drusen severity. In buried ONHD, the abnormality rate was significantly higher with GCIPL compared to RNFL evaluation, suggesting that GCIPL analysis might be an early structural indicator of neuronal loss in the setting of thickened RNFL.

Clinical features of reticular pseudodrusen according to the fundus distribution.

BACKGROUND: To evaluate the morphological features and prevalence of accompanying late age-related macular degeneration (AMD) according to the fundus distribution of reticular pseudodrusen (RPD). METHODS: According to the involved area in the fundus, the distribution of RPD was classified as localised, intermediate, or diffuse type. Morphology of RPD was classified as discrete, branching, or confluent pattern. The presence of late AMD was evaluated. RESULTS: 233 eyes of 121 patients with RPD were included. The distribution of RPD was localised, intermediate and diffuse type in 30.9%, 40.3% and 28.8% of eyes, respectively. The discrete, branching and confluent morphological patterns were found in 45.8%, 44.8% and 9.7% of the localised type, and in 0%, 13.8% and 86.2% of the intermediate type, respectively. In contrast, the diffuse type showed only the confluent morphological pattern. The prevalence of accompanying late AMD was 13.9%, 13.8% and 56.7% in the localised, intermediate and diffuse type, respectively, and it was significantly higher in the diffuse type (p<0.05). CONCLUSION: RPD with diffuse distribution showed a confluent morphological pattern and a high prevalence of late AMD. RPD can be classified by the fundus distribution for the assessment of visual prognosis.

[An outline for the standard graphical documentation of pathological macular findings]. / Entwurf einer standardisierten zeichnerischen Dokumentation pathologischer Makulaveränderungen.

BACKGROUND: Accurate documentation and follow-up of pathological findings of the macula require graphical methods for clinical evaluation. METHODS: Symbols describing and identifying different findings of the macula were evolved. A pattern for the standardised representation of the macular region -- with size and distribution of different areas -- was also developed. RESULTS: Use of different symbols supported by a standard pattern of the macula as background simplifies documentation of pathological macular findings. CONCLUSIONS: Graphical documentation of pathological macular findings allows simple, inexpensive and standardised assessment of such findings.

Polarimetric nerve fiber analysis in patients with visible optic nerve head drusen.

OBJECTIVE: To evaluate the effect of visible optic nerve head drusen (ONHD) on retinal nerve fiber layer (RNFL) thickness retardation by using scanning laser polarimetry. METHODS: Twenty-three eyes of 13 patients with visible ONHD and 26 eyes of 13 age- and sex-matched control subjects were involved in the study. Ophthalmologic examination, scanning laser polarimetry with nerve fiber analyser (NFA) type II GDX, automated Humphrey visual field testing, and red-free fundus photography were performed. Eyes with ONHD were classified from grade 0 to III according to the amount of visible drusen. Thus, grade 0 discs had no clinically visible ONHD and grade III discs represented the presence of dense drusen. RESULTS: Measurements with NFA of RNFL thickness retardation showed significant decrease in eyes with visible ONHD compared with control eyes (P < 0.05). Although no significant difference was found between grade I and grade II discs regarding NFA measurements, grade III discs had significantly lower values, indicating the greater amount of RNFL loss with higher grade ONHD. Documentation of increased percentage of visual field defects with higher grade drusen was also in accordance with this finding. CONCLUSIONS: NFA can quantitatively detect the decrease in retardation of RNFL thickness in eyes with visible ONHD and can be used as an indicator of nerve fiber layer loss in these cases.