Retinal break in an area with medullated nerve fibres

Macular hole retinal detachment in extensive myelinated retinal nerve fiber and high myopia with Straatsma syndrome: A case report

Purpose

We present a case of macular hole retinal detachment (MHRD) in a patient with Straatsma syndrome, a rare condition characterized by extensive unilateral myelinated retinal nerve fibers (MRNF), high myopia, and amblyopia. This study aimed to highlight the clinical presentations, diagnostic challenges, and success of surgical interventions.

Observation

A 32-year-old Asian woman with a history of high myopia and poorly corrected vision in her right eye since childhood presented with a sudden loss of vision in the right eye. Examination revealed extensive MRNF and retinal detachment with a macular hole. A standard three-port pars plana vitrectomy was performed, and tight vitreous retinal adhesions were observed. PFCL-assisted inverted internal limiting membrane (ILM) flap technique was performed. Silicone oil was used owing to its tight vitreous retinal adhesion. Postoperatively, the macular hole was closed, the retina was reattached, and partial disappearance of the MRNF was observed.

Conclusion and importance

This case report describes a successful surgical intervention for MHRD associated with Straatsma syndrome. The PFCL-assisted inverted ILM flap technique is effective for managing complicated cases of MHRD. The partial disappearance of MRNF after vitrectomy suggests potential nerve fiber layer damage, possibly due to retinal detachment or the use of silicone oil. This case highlights the unique features of MHRD, a rare disease associated with Straatsma syndrome.

Rhegmatogenous retinal detachment associated with myelinated nerve fibers: a case report

PURPOSE

To report the management of a case of rhegmatogenous retinal detachment associated with myelinated nerve fibers.

METHODS

A 7-year-old boy presented with decreased vision in the right eye for 3 months. Fundus examination revealed total retinal detachment with a large break within the myelinated nerve fibers in the right eye. The right eye underwent pars plana vitrectomy, encirclage, relaxing retinotomy, endolaser, and C3F8 injection.

RESULTS

The retina remained attached at the 6-month follow-up with visual acuity of 6/18, N10.

CONCLUSION

An area of the retina with myelinated nerve fiber is stiff and could potentially pose problems in retinal reattachment when a retinal break is located within the same area.

Syndrome of myelinated retinal nerve fibers, myopia, and amblyopia: a review

Myelinated retinal nerve fibers are developmental anomalies that are present in approximately 1% of all eyes. They may be associated with ipsilateral high myopia and amblyopia, and also may occur in association with various ocular and systemic abnormalities. Lesions may be congenital or acquired, static or dynamic, and can regress in the setting of several described conditions. The pathogenesis is thought to be due to the presence of ectopic oligodendrocyte-like cells in the retina as a result of a development or acquired insult. Visual acuity is typically poor to begin with, and the improvement of visual function in patients undergoing occlusion therapy has been, in general, limited. We discuss a series of 11 patients seen at the Cole Eye Institute with the condition of myelinated retinal nerve fibers, myopia, and amblyopia and describe the clinical characteristics. Three patients also had optic nerve dysplasia and a discussion of the literature related to this association was also performed.