Optic disc drusen and retinal ganglion cell apoptosis

Abstract

A patient with optic disc drusen and life-long low systemic blood pressure suffered several successive neuro-ophthalmic manifestations over a 30-year period (probably bilateral juvenile disc and preretinal hemorrhages, unilateral probably ischemic optochiasmatic neuropathy, established progressive night blindness, and mimic open-angle glaucomatous field loss), but always had normal intra-ocular hydrodynamics and pressure. Each of these manifestations may possibly be drusen-related, but may also appear independently of drusen. Drusen-related apoptosis of retinal ganglion cells may be the reason, explaining the ascending, evenly distributed, axonal optochiasmatic atrophy. In mimic open-angle glaucomatous disease cases with a similar evolution of visual fields but without drusen, axonal atrophy and (primary) loss of retinal ganglion cells has been reported as the only striking histopathological feature.