Unsuccessful surgical excision of optic nerve drusen.

BACKGROUND: To report the case of failed surgical excision of optic nerve drusen (OND). METHODS: Case report. A 53-year-old woman presented with bilateral OND leading to progressive field defects and LE light perception and RE 20/25 vision. A vitrectomy was performed on the legally-blind left eye to test the resectability of OND. RESULTS: The removal of superficial OND failed because the singular-appearing superficial OND presented as one large mass with multiple excrescences on its surface. Retinal vessels passed through it, which made an excision impossible. CONCLUSION: OND cannot always be removed surgically, due to their variable consistency and hardness.

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 drusen of the optic disk]. / Complications hémorragiques des druses de la papille.

INTRODUCTION: The hemorrhagic complications of the optic disk drusen are rare and interesting because of their functional implications, the difficulty of the differential diagnosis and the uncertain pathogeny. MATERIAL: and methods: Retrospective study of 6 cases with a complete general and ophthalmological examination, followed between 2 and 9 years. RESULTS: The average age of the cases was 38.5 years (9-62 years). The visual acuity was slightly affected and reversible in the papillary hemorrhages (1 case), low and partial reversible in the extended hemorrhages (4 cases), severe affected and irreversible in the associations with a choroidal neovascular membrane with macular implications (1 case). We found three types of hemorrhages: papillary (1 case), peripapillary associated with choroidal neovascular membrane in acute (2 cases) and cicatricial stage (1 case), extended subretinal (2 cases). The papillary drusen were profound (4 cases) and superficial (2 cases). Ultrasonography showed the presence of the optic disk drusen in both eyes in all cases. The evolution followed on a period from 2 to 9 years, revealed the resorbtion of the hemorrhages between 3 and 6 months, the reversible visual acuity in the cases without macular implication, and the absence of recidiva or bilateralisation. DISCUSSIONS AND CONCLUSIONS: The authors are presenting a number of clinical cases of papillary drusen complicated with hemorrhages, some of the cases being associated with choroidial neovascular membrane. Because of the clinical appearance, aspects of differential diagnosis with papillary edema of other etiologies are discussed. A role in the pathogeny is attributed to the direct or progressive compression of the retinal vascularisation which can provoke the erosion of the vessels and in some cases the appearance of the choroidal neovascular membrane. The suggested therapy is medical, surgical, or by photocoagulation, but the results are contradictory.

Optic disc drusen: complications and management.

BACKGROUND: Disc drusen have been found clinically in 0.3% of the population with up to 91% presenting bilaterally. Disc drusen gradually change in their ophthalmoscopic appearance throughout a patient's lifespan. This case highlights the possible ocular complications of disc drusen and the complexity in their treatment because of the risk of visual acuity loss. CASE REPORT: A 43-year-old patient with documented bilateral buried disc drusen presented without symptoms for a routine examination. A subretinal neovascular membrane (SNVM) one quarter of a disc diameter in size with an adjacent subretinal hemorrhage was observed in the right eye with a small subretinal hemorrhage in the fellow eye. The patient was evaluated by a retinologist who deferred photocoagulation of the SNVM considering its nasal disc location. CONCLUSIONS: Diagnosing disc drusen is critical because of the serious pathology they can mimic, including disc edema. Although typically benign, patients with disc drusen should be monitored on a regular basis to rule out ocular complications, which can be potentially sight threatening.

Surgical removal of peripapillary choroidal neovascularization associated with optic nerve drusen.

PURPOSE: To assess the anatomical and functional results after surgical removal of peripapillary choroidal neovascularization (CNV) associated with optic nerve head drusen. METHODS: A retrospective study was carried out on four eyes (four patients) undergoing vitrectomy, retinotomy, and removal of CNV associated with optic disk drusen. CNV was preoperatively demonstrated by fluorescein angiography in all cases. In three cases, the CNV had a subfoveal extension, and a serous-hemorrhagic retinal detachment was the cause of the central vision disturbance in the remaining one. Optic nerve head drusen were bilateral and were confirmed with computed tomography scan. RESULTS: Visual acuity (VA) improved in all cases after a follow-up ranging from 12 to 42 months. Preoperative VA was 20/200, 20/200, 20/50, and count fingers and final VA was 20/50, 20/25, 20/25, and 20/30, respectively. There was no evidence of CNV recurrence during the follow-up period. CONCLUSION: The results of surgical removal of peripapillary CNV with macular involvement associated with optic nerve head drusen are very encouraging, especially if we consider the variable outcome of the natural course in these cases.

Optic disk drusen, peripapillary choroidal neovascularization, and POEMS syndrome.

PURPOSE: To report the case of a 64-year-old woman with peripheral neuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome, Castleman disease, optic nerve drusen, and peripapillary choroidal neovascularization. METHODS: Interventional case report. Clinical practice. RESULTS: Laser photocoagulation resolved the peripapillary choroidal neovascularization. CONCLUSION: This is the first documented case of optic disk drusen and peripapillary choroidal neovascularization associated with POEMS.