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HEMORRHAGIC COMPLICATIONS OF OPTIC NERVE HEAD DRUSEN ON SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY

Lee, Kyoung Min MD*,†; Hwang, Jeong-Min MD*,‡; Woo, Se Joon MD*,‡

doi: 10.1097/IAE.0000000000000040
Original Study

Purpose: To describe the clinical features of hemorrhagic complications secondary to optic nerve head drusen (ONHD) using spectral domain optical coherence tomography (SD-OCT).

Methods: Sixty-three consecutive patients with SD-OCT–documented ONHD who presented at Seoul National University Bundang Hospital from December 2009 to July 2012 were included. Full ophthalmologic examinations, including fundus photographs, SD-OCT, fundus angiography, and visual field tests were analyzed in a total of 101 ONHD-positive eyes from 63 patients.

Results: Hemorrhagic ONHD complications were found in 7 eyes (7%) from a total of 101 eyes with ONHD. All of them had buried ONHD (visualized with SD-OCT) and myopia (mean spherical equivalent = −4.00 ± 2.35 diopters). Patients with ONHD hemorrhagic complications had smaller disk diameters than patients without hemorrhagic complications (1,308 ± 166 vs. 1,555 ± 217 μm, P = 0.004). Peripapillary hemorrhages were classified into the following 3 types based on SD-OCT findings: subretinal (6 eyes, 86%), retinal (5 eyes, 71%), and vitreous hemorrhage (4 eyes, 57%). Six patients (86%) complained of the recent onset of visual symptoms, but visual acuities at presentation were 20/20 in all patients. In the three patients who were followed up, most hemorrhages were absorbed without complications.

Conclusion: Peripapillary hemorrhage can often occur in patients with buried ONHD and small disk diameters. As SD-OCT can be used to visualize ONHD beneath hemorrhage, it is helpful with the differential diagnosis and follow-up evaluation.

Spectral domain optical coherence tomography is useful in the differential diagnosis of peripapillary hemorrhage, including hemorrhagic complications of buried optic nerve head drusen.

*Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea;

Department of Ophthalmology, 15th Special Missions Wing, Republic of Korea Air Force, Seongnam, Korea; and

Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea.

Reprint requests: Se Joon Woo, MD, Department of Ophthalmology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi-do 463-707, Korea; e-mail: sejoon1@snu.ac.kr

None of the authors have any financial/conflicting interests to disclose.

K. M. Lee and J.-M. Hwang equally contributed to the work and therefore should be considered equivalent authors.

© 2014 by Ophthalmic Communications Society, Inc.