Juxtapapillary subretinal pigment epithelial polypoid pseudocysts associated with unilateral tilted optic disc: case report with clinicopathologic correlation

[Spontaneous macula hemorrhage. Subhyaloid/sub-inner limiting membrane (ILM)]

This case study describes the clinical findings of two patients with spontaneous subhyaloid and sub-inner limiting membrane preretinal macular hemorrhage including ophthalmoscopy, optical coherence tomography (OCT) and fluorescein angiography (FAG), which are typical for a Valsalva retinopathy. The improvement of the decreased visual acuity was achieved in one case by spontaneous resorption and in the other case by pars plana vitrectomy. The etiology, diagnostic criteria and therapeutic options are discussed.

Tilted optic disks

Tilted optic disks are a common finding in the general population. An expression of anomalous human development, the tilted disk appears rotated and tilted along its axes. Visual sequelae described with tilted optic disks include myopia, astigmatism, visual field loss, deficient color vision, and retinal abnormalities. Although the natural course of tilted optic disks is nonprogressive, the anomaly can be mistaken for tumors of the anterior visual pathway, edema of the optic nerve head, or glaucoma. A thorough examination of patients with tilted disk includes refraction, dilated fundus examination, and visual field testing. At times, neuroimaging may be necessary to arrive at the correct diagnosis. Until normative data are validated for tilted disks, the role of new imaging technologies for the optic nerve head is limited. Familiarity with the spectrum of ophthalmoscopic appearance and the clinical manifestations of tilted disks may be the most critical factors in avoiding misdiagnosis.

Tilted disc syndrome in Congolese patients

PURPOSE

To determine the frequency of tilted disc syndrome and its associations with ocular parameters in Congolese patients.

METHODS

We performed a cross-sectional and descriptive analysis of the data from patients diagnosed with tilted disc syndrome. Data were collected between January 2005 and August 2008 in a general ophthalmology practice. Patients received a complete ophthalmic examination that included measurement of visual acuity, refraction, slit-lamp biomicroscopy, Goldmann applanation tonometry, examination of the visual field using the Goldmann perimeter and ophthalmoscopy. The diagnosis of tilted disc syndrome was based on ophthalmoscopic findings and fundus photographs.

RESULTS

Out of 4600 patients seen during the study period, 30 (57 eyes) had a diagnosis of tilted disc syndrome, giving a frequency of 0.6%. The mean age of the patients was 42+/-15 years (SD) (range, 16-66 years). Twelve (40%) of the patients were men and 18 (60%) were women. TDS was bilateral in 95% of cases. Mean VA was 0.02+/-0.17 logMAR (range, 0.5 to-0.18). The refractions (in spherical equivalents) varied from -11.00 to +1.5 diopters (mean, -2.27+/-4.47 D). Refractive astigmatism varied from 0 D to 2.5 D (mean, 0.73+/-0.80 D). Myopia was found in 50% and astigmatism greater than 0.5 D in 42% of eyes. Mean intraocular pressure was 13.7+/-5mmHg. Superior temporal or temporal visual field defects were found in 75% of eyes. Of 30 patients with TDS, a 25-year-old female patient had TDS associated with oculocutaneous albinism, pseudoxanthoma elasticum, and epicanthus.

CONCLUSION

This study confirmed that TDS affects all ethnic populations and can also occur in the sub-Saharan region. It is found more in females and is associated with myopia. This study shows that TDS demonstrates similar findings to those found previously in Caucasians and Asians.