We report a case of optic disc drusen (ODD) associated with peripapillary polypoidal choroidal vasculopathy (PCV). A 62-year-old Malay lady presented with both eye ODD and the left eye associated with peripapillary subretinal hemorrhage. Ultrasound B-scan and red-free photography confirmed the optic nerve head drusen findings bilaterally. Optical coherence tomography (OCT) of the left eye showed sharply elevated peripapillary pigment epithelial detachment with subretinal fluid. The presence of peripapillary polyps with branching vascular network in indocyanine green angiography of the left eye further confirmed the diagnosis of PCV and excluded choroidal neovascularization (CNV) secondary to ODD. Subsequently, the patient was treated with a combination of verteporfin photodynamic therapy with three monthly intravitreal ranibizumab injections. Three months after the combined treatment, OCT showed completely resolved subretinal fluid. ODD can cause compression of the subretinal vessels at the optic disc that results in retinal ischemia and release of vascular endothelial growth factor, which may trigger the development of CNV or PCV. The rarity of this combination makes it interesting to study more cases of ODD with PCV. Importantly, a thorough evaluation in distinguishing the PCV from the CNV that mimics it is crucial for early detection and prompt intervention. In this case, indocyanine green angiography (ICGA) is the diagnostic method to differentiate the PCV from CNV secondary to ODD.
Senior-Loken syndrome is a rare disorder that presents in the first two decades of life. It commonly manifests with nephronophthisis and retinal dystrophy. We describe a teenager who had end-stage renal failure presenting with bilateral visual impairment due to retinal dystrophy with concomitant unilateral Coats disease and exudative retinal detachment. The patient was treated with a combination of endolaser photocoagulation and external drainage of the subretinal fluid. The final visual acuity remained poor in both eyes. Options of treatment in this challenging situation is discussed in this case report.
A 42-year-old Chinese man, known case of renal cell carcinoma with lung metastasis, was referred to Universiti
Kebangsaan Malaysia Medical Centre for left eye blurring of vision for one month duration, which was worse upon
waking up in the morning and cleared up after 1-2 hours. On examination, visual acuities were 6/6 in both eyes. No
relative afferent pupillary defect. Left fundus showed inferonasal retinal detachment without macular involvement.
No retina break, no retinitis and no choroidal lesion seen. Right eye examination was normal. Optical coherence
tomography (OCT) of left eye showed subretinal fluid temporal and inferior to optic disc. Fundus fluorescein
angiography (FFA) left eye showed hypofluoresence in early phase but hyperfluorescence with pin point leakage in
late phase over inferonasal quadrant. Indocyanine green (ICG) showed early hypofluoresence with late pin point
hyperfluoresence in the same quadrant. A clinical diagnosis of exudative retinal detachment due to choroidal
metastasis secondary to renal cell carcinoma was made. The patient was planned for cyber-knife radiotherapy of his
left eye but unfortunately we lost the follow up. High index of suspicion and relevant investigation are needed for
patients with visual complaints and history of renal cell carcinoma to diagnose choroidal metastasis.