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Background: Optic nerve head drusen are acellular hyaline deposits located anterior to the lamina cribrosa, frequently associated with visual field defects. Sometimes rapid worsening of vision may occur due to complications such as acute vascular events, choroidal neovascularization, or serous maculopathy. Case Presentation: Although there are no proven treatments for Optic nerve head drusen associated field loss, we present the case of a patient with Optic nerve head drusen and bilateral rapid progression of visual field loss that has stabilized on intraocular pressure lowering medication. This suggests a role for IOP-mediated retinal ganglion cell loss in this individual. The mechanism of progressive Optic nerve head drusen associated field loss is poorly understood, however experimental glaucoma models and human in vivo imaging studies have shown that structural differences within the optic nerve head are likely to contribute to individual susceptibility to IOP-mediated damage. Conclusion: We propose that eyes with Optic nerve head drusen may be less able to dampen IOP mediated stress, contributing to loss of retinal ganglion cells in some patients.
Campa ClaudioCorresponding author Sant’Anna University Hospital, Ferrara, Italy
Idiopathic macular telangiectasia type 2 is a rare retinal condition usually characterized by parafoveal telangiectatic vessels, hyperplastic pigment plaques and seldom a full thickness macular hole or a retinal neovascularisation. Herein we describe an atypical presentation of this disease. Methods Review of the patient’s clinical and angiographic records. Results A 87-year-old white man was diagnosed with idiopathic macular telangectasia type 2. Ophthalmological and angiographic examination disclosed telangiectasia of the parafoveal capillaries together with extensive bilateral granular soft drusen and unilateral retinal angiomatous proliferation (RAP). Initially photodynamic therapy with verteporfin (PDT) and subsequently intravitreal injections of bevacizumab were used to treat RAP lesion. This approach provided visual acuity stabilization up to 24 months. Conclusion This case of ours shows that drusen may be a feature of macular teleangiectasia type 2. It also emphasizes that PDT and anti-VEGF therapy are both safe and effective for treating neovascular complications of this disease.