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Case of the Day

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OPTIC NERVE DRUSEN + RETINITIS PIGMENTOSA

Ayushi Gupta and Vishal Agrawal

This 24YO male has a known history of retinitis pigmentosa (RP) with long-standing stable vision loss. Vision was 20/50 OD and 20/200 OS.

Color photography OD shows classic RP findings, including mid-peripheral intraretinal pigment migration (bone spicules), narrowed retinal vessels, and a pale disc. Extensive optic disc drusen (ODD) are present and markedly hyperautofluoresce. OCT shows outer retinal and RPE atrophy. A large disc druse is noted in the superficial inner portion of the disc, with a hyperreflective margin, hyporeflective core, and posterior shadowing. Similar findings were noted in his left eye (not shown).

Learning Points:
ODD are refractile calcific concretions that form anterior to the lamina cribrosa. They are thought to be extruded extracellular calcified mitochondria and may be inherited as an autosomal dominant trait. In patients with RP, they are present in about 10% of eyes on fundus photography (Grover et al, Ophthalmology 1997;104:295-298) and in 30% on EDI-OCT (Steensberg et al, J Neuroophthalmol 2024;44:483-487). ODD in isolation can cause progressive visual field defects or central vision loss, which can often confound assessment of RP-related vision loss.

Article of the Day

Comparison of prognostic outcomes in vitrectomy for myopic foveoschisis with foveal detachment: air tamponade versus no-air tamponade

Zhang J, Chang H, Liu S, Huang X, Chang Q.

Int J Retina Vitreous. 2026 Jun 27;12(1):127. doi: 10.1186/s40942-026-00884-5.

Summary

PPV for myopic foveoschisis with foveal detachment: Air (vs no air) tamponade increased early anatomic recovery, but similar long-term anatomic and VA outcomes — Retrospective, 47 eyes

Abstract

Purpose: To compare the efficacy of pars plana vitrectomy with or without air tamponade for patients with myopic foveoschisis (MFS) and foveal detachment (FD).

Methods: Forty-seven patients (47 eyes) with MFS and FD who underwent PPV with fovea-sparing internal limiting membrane peeling were included in this retrospective analysis. Patients were divided into air-tamponade (n = 21) and no-air-tamponade (n = 26) groups. Central foveal thickness (CFT), external limiting membrane (ELM) / ellipsoid zone (EZ) integrity, best-corrected visual acuity (BCVA), and incidence of complications were compared.

Results: In longitudinal analysis, the air-tamponade group had significantly faster CFT reduction at 1 week and 1 month (both P < 0.05). By 3 and 12 months, the CFT values were comparable between groups. Time to foveal reattachment was shorter with air tamponade (P < 0.001). The ELM and EZ integrity were compared at 12 months (both P > 0.05). Postoperative BCVA showed significant improvement from baseline at 3 and 12 months in both groups (P < 0.05). The time-by- tamponade type interaction at 3 and 12 months was not significantly different on BCVA in multivariable model (P > 0.05). Baseline diameter of FD was identified as an independent risk factor of 12-month BCVA by multivariable analysis. Complication rates, including postoperative macular hole, macular hole with retinal detachment, and transient aggravation, did not significantly differ between groups.

Conclusion: Air tamponade accelerated early anatomical recovery in MFS with FD, but both tamponade types achieved comparable long-term anatomical and visual outcomes. Baseline FD diameter was the independent predictor of visual outcome.

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