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| CLINICAL IMAGE |
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| Year : 2018 | Volume
: 11
| Issue : 3 | Page : 272-273 |
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Large drusen in long-standing retinal detachment
Rajiv Raman1, Md Shahid Alam2, Kushal Delhiwala1, Jyotirmay Biswas3
1 Department of Orbit, Oculoplasty, Reconstructive and Aesthetic Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
2 Department of Oculoplasty Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
3 Department of Ocular Pathology and Uveitis, Sankara Nethralaya, Chennai, Tamil Nadu, India
| Date of Web Publication | 29-Oct-2018 |
Correspondence Address:
Dr. Jyotirmay Biswas
Department of Ocular Pathology and Uveitis, Sankara Nethralaya, College Road, Chennai - 600 006, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0974-620X.244306
 Abstract | | |
Drusen are seen as an end result of various biochemical insults to the retina and have been described in various clinical settings. We would like to report the histopathology of a case of large drusen, seen associated with chronic retinal detachment in a case of childhood trauma, where the eye was eviscerated for other reasons.
Keywords: Giant drusen, large drusen, long standing retinal detachment
How to cite this article:
Raman R, Alam MS, Delhiwala K, Biswas J. Large drusen in long-standing retinal detachment. Oman J Ophthalmol 2018;11:272-3 |
| Introduction | |  |
Clinically drusen are seen in age-related macular degeneration, choroidal nevus, optic nerve head drusen, and membranoproliferative glomerulonephritis.[1],[2] Histopathologically, drusen have been reported to be associated with long-standing retinal detachment (RD) and there is evidence of reversal after successful retinal reattachment surgery.[3],[4]
A 23-year-old woman presented with complaints of intermittent pain in the right eye for the last 2 years. She had a penetrating injury at the age of 4 years for which she underwent primary corneal wound repair followed by membranectomy with anterior vitrectomy for traumatic cataract and penetrating keratoplasty for corneal scarring. However, on follow-up, she developed closed-funnel RD and phthisical changes on ultrasonography B scan and was deemed inoperable. The patient subsequently underwent evisceration with ball implant.
Hematoxylin and eosin stained sections showed a disorganized retina and choroidal tissues with extensive hemorrhage [Figure 1]. Multiple-large spherical structures with a fibrillar radiating spoke-like appearance were seen situated beneath the retinal pigment epithelium (RPE). These measured approximately 0.2 mm in diameter and stained positively with periodic acid-Schiff (PAS) and Masson trichrome stains [Figure 2] and [Figure 3]. Microcalcification and focal osseous metaplasia were also noted in the specimen. | Figure 1: Photomicrograph showing the multiple-large spherical structures with a fibrillar radiating spoke-like appearance situated beneath the retinal pigment epithelium on hematoxylin and eosin staining (×100 and ×400)
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 | Figure 2: Photomicrograph showing the multiple-large spherical structures with a fibrillar radiating spoke-like appearance situated beneath the retinal pigment epithelium on periodic acid-Schiff staining (×100 and ×400)
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 | Figure 3: Photomicrograph showing the multiple-large spherical structures with a fibrillar radiating spoke-like appearance situated beneath the retinal pigment epithelium on Masson trichrome staining (×100 and ×400)
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| Discussion | | |
Drusogenesis is a complex and multifactorial process which happens over many years and causes direct impact due to physical displacement of the RPE monolayer and photoreceptors and indirect influence due to activation of the immune system and local inflammation.
The occurrence of large drusen following long-standing RD has been reported previously. It has been proposed that long-standing RD can cause RPE metaplasia which subsequently leads to drusen formation and osseous metaplasia.[5] However, the disappearance of drusen following chronic RD has also been noticed.[4] It should be differentiated from giant drusen which are hamartomatous cellular lesions seen in tuberous sclerosis and which are located more superficially in the optic nerve head and the adjacent retina. They are characterized by astrocytic hyperplasia.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Shields CL, Mashayekhi A, Materin MA, Luo CK, Marr BP, Demirci H, et al. Optical coherence tomography of choroidal nevus in 120 patients. Retina 2005;25:243-52.  |
| 2. | Mullins RF, Aptsiauri N, Hageman GS. Structure and composition of drusen associated with glomerulonephritis: Implications for the role of complement activation in drusen biogenesis. Eye (Lond) 2001;15(Pt 3):390-5. |
| 3. | Shenoy SK, Babu K, Prabhakaran VC. Large drusen following long-standing retinal detachment. Indian J Pathol Microbiol 2010;53:329-30. [ PUBMED] [Full text] |
| 4. | Lim LT, Holicki J, Walker JD. Disappearance of extramacular drusen after chronic retinal detachment. Oman J Ophthalmol 2012;5:67. [ PUBMED] [Full text] |
| 5. | Vemuganti GK, Honavar SG, Jalali S. Intraocular osseous metaplasia. A clinico-pathological study. Indian J Ophthalmol 2002;50:183-8. [ PUBMED] [Full text] |
[Figure 1], [Figure 2], [Figure 3]
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