Optic disc drusen and peripapillary subretinal neovascular membranes in children

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Abstract

Purpose

Choroidal neovascular membranes are a rare cause of decreased vision in children with optic disc drusen. It can cause central vision loss by subfoveal progression of the choroidal neovascularization, serous macular detachment, or submacular hemorrhage.

Methods

We report two cases of optic nerve head drusen in childhood. A 6 year-old girl and a 12 year-old boy were both refered to our hospital for optic disc edema with unilateral visual loss

Results

Fundus examination showed pseudopapillary edema in the two cases. A pediatric check-up with neurologic and cardiovascular exams and CT scan were performed. B-Scan ultrasonography showed the presence of the optic nerve head drusen in both eyes but wasn’t identified on CT scan in the two cases. In our cases, optic disc drusen causes peripapillary haemorrhages proceeding from the same mechanism with a juxtapapillary choroidal neovascularization. Because of the location of the hemorrhage only monitoring was recommended. Partial spontaneous visual acuity improvement in 6 months was observed with regression of haemorrhage.

Conclusion

Optic nerve head drusen are calcified deposits arising from the prelaminar portion of the optic nerve, they have a reported prevalence of 0.4% in children. Although usually benign, their presence can sometimes be associated with serious ocular conditions and cause amblyopia. They have been reported to cause myriad local vascular complications, including central retinal artery and vein occlusion and peripapillary choroidal neovascularization.

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