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 Table of Contents    
LETTER TO THE EDITOR
Year : 2012  |  Volume : 5  |  Issue : 1  |  Page : 67  

Disappearance of extramacular drusen after chronic retinal detachment


1 Tennent Institute of Ophthalmology, Glasgow, United Kingdom
2 Holicki Eye Institute, Coldwater, MI, USA
3 Indiana University School of Medicine, Fort Wayne, IN, USA

Date of Web Publication7-Apr-2012

Correspondence Address:
Lik Thai Lim
Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow G12 0YN
United Kingdom
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-620X.94793

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How to cite this article:
Lim LT, Holicki J, Walker JD. Disappearance of extramacular drusen after chronic retinal detachment. Oman J Ophthalmol 2012;5:67

How to cite this URL:
Lim LT, Holicki J, Walker JD. Disappearance of extramacular drusen after chronic retinal detachment. Oman J Ophthalmol [serial online] 2012 [cited 2019 Sep 15];5:67. Available from: http://www.ojoonline.org/text.asp?2012/5/1/67/94793

Sir,

We present a patient who developed a chronic retinal detachment and following successful surgical repair, she had a dramatic resolution of extramacular drusen.

A 90-year-old white female presented with a 1½ month history of decreased vision in her left eye. Her past ocular history included being pseudophakic for the last 10 years with long-term extensive bilateral symmetrical extramacular drusen. Her past medical history included hypertension. On examination her vision was 20/30 in the right eye and hand motions in the left. The left eye had an almost total retinal detachment that was successfully repaired with combined vitrectomy and scleral buckle. Postoperatively her vision improved to 20/60 and almost all the extramacular drusen in the operated eye had disappeared [Figure 1].
Figure 1: Composite fundus photographs showing extensive extramacular drusen in the right eye and almost total resolution of the drusen in the left eye following repair of a chronic retinal detachment. The depigmented area at the top of the operated eye is the retinotomy site. Before the operation both fundus showed similar distribution and intensity of extramacular drusen

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It is well documented that drusen can disappear spontaneously, often resulting in patches of retinal pigment epithelial atrophy. [1] The absorption of drusen can also be stimulated with low fluence laser treatment although the mechanism is unknown. No study to date has demonstrated such treatment improves the visual outcome. [2] There has also been a report of a patient who had some resolution of macular drusen subsequent to macular hole surgery. [3]

To our knowledge, this particular cause of extramacular drusen disappearance has not been described in the literature. There is one similar case, wherein, the drusen disappeared after rhegmatogenous retinal detachment repair, but that case involved subfoveal drusen only. [4] The mechanism of the drusen disappearance is not fully understood, but it can be postulated that chronic exposure of the apical pigment epithelium to subretinal fluid may have allowed diffusion of the drusen material into subretinal space. Alternatively, the lack of outer segment disposal during the period of retinal detachment may have allowed drusen to clear through Bruch's membrane. There is no sign of atrophic change associated with the drusen disappearance and the patient's vision improved. This suggests that efforts to atraumatically reverse drusen formation may ultimately prove beneficial in conditions such as age-related macular degeneration.

 
   References Top

1.Abdelsalam A, Del Priore L, Zarbin MA. Drusen in age-related macular degeneration: Pathogenesis, natural course, and laser photocoagulation-induced regression. Surv Ophthalmol 1999;44:1-29.  Back to cited text no. 1
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2.Parodi MB, Virgili G, Evans JR. Laser treatment of drusen to prevent progression to advanced age-related macular degeneration. Cochrane Database Syst Rev 2009: CD006537.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Holz FG, Staudt S. Disappearance of soft drusen following macular hole surgery. Retina 2001;21:184-6.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Margolis R, Ober MD, Freund KB. Disappearance of drusen after rhegmatogenous retinal detachment. Retin Cases Brief Rep 2010;4:254-6.  Back to cited text no. 4
    


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