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A case report of 45 years old patient with non-arteriitic anterior ischemic optic neuropathy (NAION) associated with drusen of the optic nerve, in the literature called as drusen associated AION (DAION), accompanied by sudden central visual loss with constant outcomes is presented. In the non-arteriitic anterior ischemic syndrome with minimum of vascular factors, it is necessary to consider the finding of drusen as possible cause, because they may be deeply located, one-sided, and the optic nerve head edema may conceal the finding. The ultrasound is the most available examination method to confirm this diagnosis.

Forty-five patients (83 eyes) aged 17 to 80 years with optic disc drusen (ODD) were examined. Acute anterior ischemic optic neuropathy (AION) was detected in 6% of all the cases. Chronic optic neuropathy (ON) was revealed in 60%, which was predominantly slowly, progressive, asymptomatic and manifested as changes in the paracentral and peripheral fields of vision. Ultrasound study showed small-sized ODD in patients without clinical signs of optic nerve pathology and large-sized ODD in patients with manifestations of chronic ON. ODD affected central retinal artery blood flow (CRABF): in 96.8% of the patients with chronic ON and in 45.5% of those without visual impairments. There was a relationship of the values of the field of vision and CRABF to the extent of ODD.

Optic disc drusen are acellular calcified deposits occurring in small optic discs. They have a prevalence of up to approximately 2% and are bilateral in 75% of cases. Their size and fundosc pic visibility increase with age, and they are commonly responsible for the misdiagnosis of papilloedema by the unwary. Although largely asymptomatic, they can be associated with vascular problems affecting the optic nerve. Ocular ultrasonography is the most sensitive method for their detection. This article highlights their commonly encountered clinical presentations and the practical aspects of diagnosis and management.

Purpose: To evaluate the visual acuity in patients with optic disc drusen and its relationship with the existence of superficial drusen., Methods: For a six-year period (from 1997 to 2003), fifty-five patients (100 eyes) with optic disc drusen, confirmed with B- echography, were diagnosed. According to their ophthalmoscopic appearance under 20 degrees retinography, the drusen were classified as hidden or visible. We evaluated the best corrected visual acuity. When the visual acuity was less than 0.8, other additional causes of visual impairment were studied., Results: The average visual acute in patients with papillary drusen was 0.82 (maximum 1.2 and minimum 0.05). Lower visual acute was found in those patients with visible drusen. Visual acute was statistically worse (p = 0.016) as the number of drusen increased. The visual acute was normal in 75 cases. The decreased visual acute was exclusively secondary to drusen in 5 cases. In the other 20 patients concomitant causes of visual impairment were found., Conclusions: A decreased visual acute secondary to drusen is unusual. When present, it is usually moderate and associated with disturbances of the peripheral visual field. There is a significant relationship between the decrease in visual acute and the number of visible drusen. When the central vision is decreased, but not the visual field, other concomitant conditions that could also affect the vision, should be ruled out.

Introduction: Bilateral optic disc drusen can mimic papilledema, raising the question of intracranial hypertension and sometimes prompting unnecessary or invasive procedures., State of the Art and Perspectives: Optic disc drusen are benign calcified masses, often visible within the optic nerve head. However, their clinical diagnosis can be more difficult at earlier stages of life, when they are buried within the optic nerve. Visual field loss can occur in patients with longstanding optic disc drusen., Conclusion: Ophthalmoscopy and B-scan ocular ultrasonography allow appropriate diagnosis of bilateral optic disc drusen mimicking papilledema. On rare occasions, optic disc drusen can be associated with ischemic complications, the other causes of drusen-related visual loss being exceptionally rare., (Copyright 2009 Elsevier Masson SAS. All rights reserved.)

Background: We present a case with bilateral optic disc drusen, associated in one eye with idiopathic parafoveal telangiectasis (Group 1B), basal laminar drusen, and foveal pseudovitelliform lesion., Patient: A 45-years old female patient, which complained about a deterioration of vision at the right eye, was ophthalmologically examined., Results: The examination revealed a bilateral optic disc drusen, and on the right eye a macular haemorrhage. An examination after 2 months revealed a good vision, the resorption of the macular haemorrhage, idiopathic parafoveal telangiectasis, basal laminal drusen, and a foveal pseudovitelliform lesion., Conclusions: The association is of importance because of the rarity of the haemorrhagic complication in the idiopathic parafoveal telangiectasis (Group IB), the possibility of a pathogenic correlation, and the difficulty of differential diagnosis with the optic disc drusen complicated with retinal haemorrhages. This association was not found in the literature we consulted.

Objective: To demonstrate a new algorithm that can determine the shape, location, and volume of optic nerve head drusen (ONHD), which were imaged with spectral domain optical coherence tomography (SDOCT)., Methods: One exenteration patient and 4 glaucoma patients with bilateral ONHD were recruited from the Massachusetts Eye and Ear Infirmary and from a private practice office. Images were obtained using an experimental SDOCT system developed at the Wellman Center for Photomedicine, Massachusetts General Hospital. With axial resolutions of about 6 mum, SDOCT can obtain 2-dimensional images in 1/29 of a second, compared with commercially available time domain OCT instruments with 10 mum resolution images in 1.28 seconds. The volumes of ONHD were calculated with a new algorithm and were then correlated with visual field mean deviation., Results: SDOCT can display 2-dimensional images comparable with histology and 3-dimensional videos of ONHD. ONHD are signal-poor regions with high-signaled borders. Larger ONHD volumes are directly correlated with larger mean deviation absolute values on Humphrey visual field testing., Conclusions: SDOCT is a potentially better technique for ONHD imaging and may improve the diagnosis and management of patients with both OHND and glaucoma.

Ataxia-telangiectasia (A-T) is an autosomal recessive condition presented by progressive cerebellar ataxia, oculocutaneous telangiectasia, humoral and cellular immunodeficiencies and a predisposition to malignancy. We report on a 13 years old male patient with the diagnosis of A-T associated with uncommon clinical features; optic disc drusen and vitiligo. To our knowledge, this is the first report of A-T associated with these findings.

Background: Optic nerve head drusen (ONHD) is a relatively uncommon condition that results from calcific degeneration of axons within the optic nerve. The abnormal drusen bodies can enlarge, compressing normal nerve structures, and ultimately may result in vision loss. Drusen often are discovered through clinical evaluation with a dilated funduscopic examination. Ancillary testing, including computed tomographic (CT) imaging, B-scan ultrasonography, autofluorescence imaging, nerve fiber layer imaging, and threshold visual field evaluation are helpful to confirm the existence of ONHD and to evaluate for progression of this condition., Case Report: This case report discusses the clinical presentation of a patient with advanced visual field loss from ONHD and the ancillary testing used to confirm the diagnosis. A complete review of literature on ONHD is discussed., Conclusions: Currently, there is no cure or direct treatment for progressive vision loss or complications that may develop from ONHD. Useful diagnostic tools include serial automated threshold visual fields, nerve fiber layer analysis, and fundus photography. It is suggested that ocular hypotensive agents be used to lower intraocular pressure prophylactically to prevent further nerve fiber layer and optic nerve damage.

Background: Optic disc drusen typically are considered benign findings. However, optic disc drusen can manifest with hemorrhagic complications., Case Report: A dilated fundus examination on a 27-year-old visually asymptomatic optometry student found a juxtapapillary hemorrhage one quarter of a disc diameter in size in the right eye, immediately off the superior nasal aspect of the disc. Bilateral disc drusen, confirmed by hyperreflectivity on ultrasonography, were also noted. Fluorescein angiography and optical coherence tomography were diagnostic only for a deep isolated intra- and subretinal hemorrhage. Neither diagnostic modality could confirm the presence or absence of a choroidal neovascular membrane. Because of the asymptomatic nature, location of the hemorrhage, and lack of conclusive etiology, close monitoring was recommended. After 4 months, 75% of the hemorrhage had reabsorbed with no visual complications., Conclusions: Optic disc drusen can cause ocular hemorrhages through several mechanisms. Although many are benign and self-limiting, it is important to understand available treatment modalities should vision be threatened.

Optic disc drusen are acellular calcific deposits occurring in small, crowded optic discs with abnormal vasculature. Evidence suggests axoplasmic transport alteration and axonal degeneration are involved in disc drusen formation. In affected patients, the number and size of disc drusen are highly variable, and the drusen may be visible near the disc surface or buried within the disc, causing them to appear as pseudopapilledema. B-scan echography is the most sensitive method for detecting disc drusen. Most patients with disc drusen are asymptomatic, but progressive visual field loss and vascular complications, including anterior ischemic optic neuropathy and choroidal neovascularization, may occur. Optic disc drusen have no established effective treatment. Diagnosing disc drusen correctly is important to avoid unnecessary work-up and to avoid overlooking potential serious conditions such as true papilledema. Disc drusen patients with more-than-expected visual field defects or progressive visual loss should have work-up to exclude other causes.

A 37-year-old patient presented with acute visual field loss diagnosed as non-arteritic anterior ischemic optic neuropathy in the setting of optic nerve drusen. Her visual field loss had progressed when compared to the visual field done 2 years previously. Fundus examination showed bilateral optic nerve head drusen and left retinal nerve fiber layer edema consistent with non-arteritic anterior ischemic optic neuropathy.

Optic disc drusen (ODD) are an initially symptom-free, usually bilateral, progressive type of optic neuropathy with genetic disposition. We observed visual field loss (VFL) in 64% (49 of 77) of our patients. Vascular complications such as AION are common. Initially, papilledema is often diagnosed and the diagnosis of ODD is confirmed by means of ultrasound examination. We found an average time interval of 7 years between groups of patients with preperimetric stage and onset of VFL. We also observed more advanced stages of VFL, faster progression of visual field loss and greater visibility of ODD with increasing age. VFL frequently results in loss of driving ability according to driving permission regulations. The aim of our therapy concept is to reduce intraocular pressure (IOP). In a pilot study we found that patients who underwent IOP-lowering therapy showed significantly less progression of VFL than patients who did not undergo this therapy. The present article summarizes current knowledge on epidemiology, pathogenesis, clinical presentation, diagnostics and therapy of optic disc drusen.

Background: New technology allows more precise definition of structural alterations of all retinal layers although it has not been used previously in cases of optic disc drusen., Methods: Using Stratus and Fourier domain (FD) optical coherence tomography (OCT) and adaptive optics (AO) through a flood-illuminated fundus camera, we studied the retinas of a patient with long-standing optic disc drusen and acute visual loss at high altitude attributed to ischemic optic neuropathy., Results: Stratus OCT and FD-OCT confirmed severe thinning of the retinal nerve fiber layer (RNFL). FD-OCT revealed disturbances in the photoreceptor layer heretofore not described in optic disc drusen patients. AO confirmed the FD-OCT findings in the photoreceptor layer and also showed reduced cone density at retinal locations associated with reduced visual sensitivity., Conclusions: Based on this study, changes occur not only in the RNFL but also in the photoreceptor layer in optic nerve drusen complicated by ischemic optic neuropathy. This is the first reported application of FD-OCT and the AO to this condition. Such new imaging technology may in the future allow monitoring of disease progression more precisely and accurately.

Objective: To compare visual field loss (VFL) in eyes with optic nerve head drusen (ONHD) with or without ocular hypertension (OHT)., Methods: The records of all patients aged 45 years or older with a diagnosis of ONHD at 2 centers were reviewed. OHT was defined as intraocular pressure >or=22 mm Hg. We categorized ONHD into 3 grades based on visibility on disc photographs., Results: We identified 22 eyes (13 patients) with both ONHD and OHT and 81 normotensive eyes (47 patients) with ONHD. VFL was present in 20/22 (90.9%) of hypertensive eyes compared with 54/81 (66.7%) of normotensive eyes (P=0.03, Fisher exact test). Drusen grade III and OHT were both independently and significantly associated with greater incidence of VFL (logistic regression analysis)., Conclusions: VFL occurs more frequently in eyes with ONHD that also have OHT. Eyes with grade III ONHD are at increased risk for VFL compared to eyes with grade I drusen with the same intraocular pressure status. Patients with OHT and ONHD should undergo close surveillance for disease progression and be treated appropriately to prevent additional VFL.

We report three cases of optic disc drusen in children. The children were 5 months, 10 years, and 11 years old. Two of them were male. The optic disc drusen was unilateral in two cases and bilateral in one case. One child had a history of Down syndrome and another one a history of Alagille syndrome. The third child had no particular general history but he had unilateral high myopia with optic disc drusen in the same eye. Fundus examination showed pseudopapilledema in all three cases; the disc appeared elevated and its margins were blurred. Ultrasonography of the eye demonstrated optic disc drusen in the three cases. Optic disc calcification on CT scan was identified in only one case. In children, optic disc drusen are often buried, leading to pseudopapilledema appearance of the optic disc. Ultrasonography is highly sensitive in detecting optic disc drusen, making more expensive investigations unnecessary.

Purpose: To evaluate the visual field defects in patients with visible and buried optic disc drusen., Material and Methods: 40 patients (22 women and 18 men, mean age 49.8 years) with optic disc drusen were studied prospectively for clinical and electrophysiological evidence of impaired optic nerve function. Visual acuity, colour perception, presence of an afferent pupillary defect, visual evoked potentials (VEP), and visual field were analyzed. The visual field defects were classified by their predominant pattern. Statistical analysis was performed using a chi-squared test and the Fisher exact test., Results: The visual field defects were found in 63.2% of eyes with optic disc drusen. The two most common pattern of visual field loss were enlargement of blind spot and nerve fiber bundle defects. 76.3% of eyes with visible optic disc drusen had abnormal visual fields compared with 46.5% of eyes with buried drusen, p = 0.011. Results of electrophysiological studies showed abnormal VEPs in 44.7% of eyes with visible drusen an in 20% of eyes with buried drusen, p = 0.032., Conclusion: Visual field loss are the most common visual symptoms in the optic disc drusen. Visual field defects in eyes with visible drusen are more frequent than in eyes with buried drusen. Changes in perimetry are strongly associated with visual acuity loss and abnormal VEP.

Purpose: The aim of the study is an evaluation of applicability of selected test in glaucoma diagnosis in a patient with optic disc drusen., Material and Methods: The authors describe a case of a patient examined for glaucoma because of an increased intraocular pressure and deterioration of vision. The optic disc drusen were found in the patient by ophthalmoscopy and confirmed by ultrasonography. The patient was examined by the scanning laser ophthalmoscopy HRT, scanning laser polarymetry GDX, retina thickness analysis RTA and determination of the visual field., Results: Results of diagnostic studies were presented in the paper. The scanning laser ophthalmoscopy did not evidence any presence of glaucomatous cup in the optic nerve head. The scanning laser polarymetry showed extensive losses in nerve fiber layer of retina and the retinal thickness analysis showed a reduction of the retina thickness in the posterior pole. Study of the vision field evidenced the relative and absolute scotomas., Conclusions: The results show a necessity for careful evaluation of the glaucoma examination results in patients with drusen in the optic nerve head, because of a high similarity of abnormalities produced by both diseases.

Case Reports: Three cases of pigmentary epithelial tears are described in this study. One of them was related to previous extrafoveal photocoagulation, whereas the other two were idiopathic. Fluorescein angiography (FA) and optical coherence tomography (OCT) were performed to confirm the clinical diagnosis., Discussion: Few studies using OCT to assess pigmentary retinal epithelial (RPE) tears have been published in the world literature. The main findings of our study included hyper-reflectant line breaks, choroidal hyper-reflectance due to the lack of RPE and RPE double layering where it was folded. Images were frequently associated with RPE tears and neurosensorial retinal detachment.

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.

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.

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.

We describe a case of an acute symptomatic and non-progressive visual field constriction in one eye of a 19-year-old female with optic disc drusen. The fellow eye showed slowly progressive visual field defects. A limited or retrolaminar infarction of the optic nerve head seems a plausible cause of the acute visual field loss. The slow progression in the fellow eye is most probably due to mechanical compression by the drusen. The case is documented with Humphrey perimetry during a follow-up of 11 years and with Color Doppler Imaging (CDI) of the optic nerve.

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.

Purpose: To report an insulin-dependent diabetic patient who was referred by the diabetic screening clinic as having proliferative diabetic retinopathy who was found to have bilateral optic disc drusen with optociliary shunt resembling neovascularization on the disc., Methods: Complete ocular evaluation including a fluorescein angiography was performed., Results: Fundus examination showed signs of mild nonproliferative diabetic retinopathy in the right eye and the presence of well-defined optic disc drusen in both eyes with a peculiar vascular abnormality resembling neovascularization on the right disc. The central retinal vein pulsation was normal on digital examination. Autofluorescence confirmed the presence of the optic disc drusen in both eyes. Fluorescein angiography showed no leakage from the optociliary shunt. The vascular abnormality has remained stable for 2 years., Conclusions: This case highlights the correlation of optic disc drusen and optociliary shunts which in diabetic patients can be misdiagnosed as neovascularization.

Purpose: To evaluate the autofluorescence findings of patients with pseudoxanthoma elasticum, a disease resulting from a defect in a reputed transport protein encoded by the gene adenosine triphosphate-binding cassette subtype C number 6., Design: Observational case series., Methods: Color, red-free monochromatic, and autofluorescence photography and fluorescein angiography of patients with pseudoxanthoma elasticum seen in a referral practice were evaluated., Main Outcome Measures: Cataloging of the abnormalities as detected by autofluorescence photography., Results: The 8 subjects ranged in age from 26 to 60 years (mean, 55+/-12), and their best-corrected visual acuity ranged from 20/20 to 5/400 (mean, 20/50). Of the 16 eyes of the 8 patients, all had abnormalities typical of pseudoxanthoma elasticum, including angioid streaks in 14, peau d'orange in 4, and choroidal neovascularization in 11. Angioid streaks appeared as hypoautofluorescent fissures, sometimes showing expansion of the hypoautofluorescence suggestive of retinal pigment epithelium (RPE) absence or atrophy. Peau d'orange had a stippled appearance of autofluorescence, and drusen of the optic nerve appeared as hyperautofluorescent bodies. In addition to the expansion of RPE atrophy around angioid streaks, 3 additional configurations of RPE atrophy were recognized as RPE rips in 6 eyes, multilobular areas of atrophy in 9 eyes, and broad areas of poorly demarcated atrophy in 5 eyes. Some eyes had more than one manifestation of RPE atrophy, but the latter 3 types of atrophy occurred in eyes with, but not necessary contiguous to, concurrent choroidal neovascularization., Conclusions: Autofluorescence photography demonstrated that patients with pseudoxanthoma elasticum have more widespread areas of RPE disturbance, particularly atrophy, than what is detectable by other means of ocular imaging, which suggests that the RPE disturbance may play a role in the pathogenesis of visual loss in patients with pseudoxanthoma elasticum.

Purpose: Optic nerve drusen needs to be included in the differential diagnosis of pseudopapilledema. As the identification of this entity by funduscopy may be difficult, ultrasonography has thus become the gold standard for its diagnosis. Severe optic nerve drusen has been correlated with a reduction of the nerve fiber layer measured by optic coherence tomography and with the presence of serious visual field defects. To demonstrate the relationship between extensive optic nerve drusen and visual field defects., Method: A prospective observational study of the visual fields of a series of 5 patients with severe optic nerve drusen diagnosed by ultrasonography., Results: Visual field defects of widely differing severity, from inferior nasal quadrant to severe hemivisual field defects, were described in each patient studied., Conclusions: Visual field defects of diverse severity are common in patients with deep optic nerve drusen. For that reason ultrasonography and/or optical coherence tomography is highly recommended where such visual field defects exist.

Aim: To describe the appearance of the non-exudative forms of age related macular degeneration (AMD) as imaged by ultrahigh resolution optical coherence tomography (UHR-OCT)., Methods: A UHR-OCT ophthalmic imaging system, which utilises a femtosecond laser light source capable of approximately 3 mum axial resolution, was employed to obtain retinal cross sectional images of patients with non-exudative AMD. Observational studies of the resulting retinal images were performed., Results: 52 eyes of 42 patients with the clinical diagnosis of non-exudative AMD were imaged using the UHR-OCT system. 47 of the 52 (90%) eyes had the clinical diagnosis of drusen and/or retinal pigment epithelial (RPE) changes. In these patients, three patterns of drusen were apparent on UHR-OCT: (1) distinct RPE excrescences, (2) a saw toothed pattern of the RPE, and (3) nodular drusen. On UHR-OCT, three eyes (6%) with a clinical diagnosis of non-exudative AMD had evidence of fluid under the retina or RPE. Two of these three patients had findings suspicious for subclinical choroidal neovascularisation on UHR-OCT., Conclusion: With the increased resolution of UHR-OCT compared to standard OCT, the involvement of the outer retinal layers are more clearly defined. UHR-OCT may allow for the detection of early exudative changes not visible clinically or by angiography.

The authors describe the use of photodynamic therapy with verteporfin for subfoveal choroidal neovascular membrane secondary to optic nerve drusen. A 28-year-old woman had a peripapillary choroidal neovascular membrane secondary to optic nerve drusen with significant metamorphopsia. Photodynamic therapy using verteporfin was performed. Visual acuity improved to 20/20 with resolution of metamorphopsia and absence of leakage on fluorescein angiography a few weeks after verteporfin therapy. The patient's condition remained stable for 16 months with 20/20 vision. Photodynamic therapy with verteporfin may be a useful treatment option in patients with choroidal neovascular membranes secondary to 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.

Purpose: To report a case of bilateral choroidal neovascularization (CNV) associated with optic nerve drusen (OND) treated with photodynamic therapy (PDT) with verteporfin., Methods: A 10-year-old girl with juxtapapillary CNV in the right eye and juxtapapillary and juxtafoveal CNV in the left eye associated with OND underwent PDT with verteporfin in both eyes., Results: Visual acuity increased from 20/160 to 20/25 in the right eye and from 20/1000 to 20/25 in the left eye after two sessions of PDT and 2 years of follow-up. CNV showed no leakage after two PDT sessions in both eyes and no recurrence was observed., Conclusions: Subfoveal CNV is an uncommon complication of OND and excellent anatomic and functional results can be obtained with PDT.

Background: It has been reported that visible optic disc drusen are associated with decreased visual acuity and loss of peripheral visual field. Patients with buried optic disc drusen have not been as well characterized., Methods: An observational, retrospective review was made of 92 eyes with funduscopic or ultrasonographic evidence of optic disc drusen. Demographics, presenting symptoms, visual acuity, refractive error, intraocular pressure, presence of an afferent pupillary defect, cup-to-disc ratio, appearance of the optic nerve, and visual field were recorded., Results: Fifty-one (55%) of the eyes were symptomatic; among them, 63% had symptoms of visual acuity loss, and 49% had symptoms of visual field loss. Seventy-nine (86%) of the optic discs appeared abnormal on ophthalmoscopy, but only 42% of these had visible drusen. Forty-five (49%) of the eyes had a visual field defect, and 73% of these were nerve fiber bundle in type. Overall, 73% of optic discs with visible drusen had abnormal visual fields compared with only 36% of optic discs with buried drusen (P < 0.05)., Conclusions: Among 92 eyes with optic disc drusen, only slightly more than 50% produced visual symptoms. Fewer than 50% of drusen were visible ophthalmoscopically. Buried optic disc drusen identified by ultrasound had a significantly lower frequency of associated visual field defects than did visible optic disc drusen.

Purpose: To report two cases of choroidal neovascular membrane associated with optic disc drusen which were successfully treated using argon laser photocoagulation., Methods: Choroidal neovascular complications of optic disc drusen were diagnosed in two of our patients, a 36-year-old woman and a 14-year-old girl. In both cases visual acuity was 20/100 in the affected eye. Fundus examination and angiography revealed a choroidal neovascular membrane. Computer tomography identified bilateral calcified drusen of the optic discs. Photocoagulation of neovascular tissues was immediately performed., Results: Visual acuity improved progressively, reaching 20/20 10 months after treatment in one case and 20/30 in the other. No recurrence was observed during follow-up., Conclusion: Early diagnosis and immediate laser photocoagulation of vision-threatening choroidal neovascular membranes associated with optic disc drusen helps stop progression towards the macula and improves longterm visual acuity.

Background: There have been anecdotal reports of anterior ischemic optic neuropathy (AION) occurring in eyes with optic disc drusen (ODD), but the clinical features of this condition have not been well characterized., Objectives: To better describe the clinical features of AION associated with ODD and to compare the clinical features of this condition with those of "garden variety" nonarteritic AION., Methods: We reviewed the medical records of 20 patients who experienced an episode of AION in an eye with ODD. In 4 patients, both eyes were affected; thus, 24 eyes were studied. The diagnosis of ODD was made by ophthalmoscopic identification, orbital ultrasonography, or computed tomographic scanning. We recorded age, sex, vascular risk factors, symptoms, visual acuity, visual fields, and results of the follow-up examination in all patients. These findings were compared with data from previously reported series of patients with nonarteritic AION., Results: Our 20 patients included 14 men and 6 women (age range, 18-69 years; mean, 49.4 years). Vascular risk factors were identified in 10 patients (50%). Three patients reported episodes of transient visual loss before their fixed deficit. The visual acuity at the initial examination was 20/60 or better in 15 (62%) of the 24 eyes; 8 had a visual acuity of 20/20. The predominant pattern of visual field loss was an altitudinal or arcuate defect in 19 (79%) and a centrocecal scotoma in 5 (21%) of the 24 eyes. There was subjective worsening of vision before the initial neuro-ophthalmic examination in 11 eyes (46%) and objective documentation of progression in 7 eyes (29%). The final visual acuity was 20/40 or better in 13 (62%) of 21 eyes and 20/200 or worse in 3 (14%) of 21 eyes., Conclusions: Our patients were strikingly similar to those with nonarteritic AION unassociated with drusen in regard to prevalence of vascular risk factors, pattern of visual field loss, and occurrence of a subsequent similar event in the fellow eye. In contrast, however, patients with ODD-AION were younger than those with nonarteritic AION, were more likely to report preceding episodes of transient visual obscuration, and enjoyed a more favorable visual outcome.

Optic disc drusen are the inherited changes, which occur in about 0.3% of the population. The optic discs of patients with drusen characteristically show a lumpy, bumpy border and bright irregular deposits. Drusen are generally asymptomatic, but in some cases visual defects occur. B-scan sonography, fluorescein angiography and computed tomography are the best imaging procedures for diagnosing of the optic disc drusen. Drusen are quite often associated with various vascular anomalies and complications. Patients with retinitis pigmentosa and angioid streaks have a higher prevalance of drusen. Although, no effective treatment of optic disc drusen has been established, regular examinations should be carried out in order, to recognize accompanying complications. This paper presents current knowledge on the pathogenesis, diagnostics, vascular changes and disorders associated with the optic disc drusen, as well as on their complications and management.

Optic disc drusen make examination towards glaucoma difficult to interpret. They change nerve head morphology and visual field defects can resembling glaucomatous damage. Patient with strong headache was examined and we found drusen on both optic nerve heads and intraocular pressure about 27 mmHg. Visual fields demonstrated scotomas--in lower half and the enlargement of the blind spot. After topical treatment and intraocular pressure normalization, the patient's complaints had gone. Control examination after one year revealed progression of visual field changes. Electrophysiological examination showed abnormalities typical for glaucoma.

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.

Optic disc drusen are congenital and developmental anomalies of the optic nerve head seen commonly in clinical practice, often as an incidental ophthalmologic finding during routine exams. Optic disc drusen are a form of calcific degeneration in some of the axons of the optic nerve. Visual acuity is often not affected but the visual fields of these patients can be abnormal and deteriorate over time. Optic disc drusen are familial and are not uncommon. They are thought to be the result of pathology at the level of the optic nerve head itself. The diagnosis can be made with clinical findings combined with B scan ultrasound and computed tomography. In addition, newer modalities using optic nerve head tomography are proving to be very useful. Since children as well as adults are affected, it is important to consider optic nerve head drusen in the differential diagnosis of papilledema or optic nerve swelling.

Purpose: We report a rare case of optic nerve drusen associated with Grönblad-Strandberg syndrome., Case: The patient was a 29-year-old woman who had pseudoxanthoma elasticum on her neck., Observations: On eye examination, there were no abnormal findings in the anterior segment or ocular media. Ophthalmoscopic examination revealed milky white granular lesions on the optic nerve disc, and angioid streaks around the disc in both eyes. Orbital computerized tomography(CT), B-scan echography and photography with a fluorescein angiography filter identified the granular lesions as optic nerve drusen. With a scanning laser ophthalmoscope(SLO), poorly-visible drusen buried below the nerve head could be detected. The optic nerve drusen could be seen more clearly by infrared laser than by helium-neon laser., Conclusions: SLO using infrared laser is useful for evaluation of superficial and buried 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.

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.

A 24-year old man complained of decreased vision in his right eye for 1 week. Examination revealed a subtle right optic neuropathy. Fundoscopy showed bilateral buried drusen, which were confirmed with B-scan ultrasonography. An MRI was normal.