Bevacizumab for Macular Serous Neuroretinal Detachment in Tilted Disk Syndrome

Abstract

Background. Tilted disc syndrome (TDS) is a congenital anomaly characterized by “tilting” of the optic disc tipycally associated with myopic astigmatism, visual field defect, inferior staphyloma, and retinal pigment epithelium atrophy. Associated complications such as macular serous neuroretinal detachment are well described; however, ideal therapy for such complication is unknown. Methods. One interventional case report is hereby described. A patient affected by macular serous neuroretinal detachment-complicated tilted disk syndrome underwent a complete ophthalmic examination. Optical coherence tomography and fluorescein angiography were taken at baseline and at scheduled visits. Two intravitreal treatments of bevacizumab (avastin, 1.25 mg/0.05 mL) were performed at monthly interval. Results. At scheduled visit, one month after the second injection, OCT depicted persistence of neuroretinal detachment. Best-corrected visual acuity remain stable as well as metamorphopsia and functional discomfort. Conclusion. Clinical evidence of this brief interventional case report indicates that one patient affected by recent serous macular detachment-complicated TDS did not benefit from 2 consecutive monthly intravitreal Avastin treatments. Best-corrected visual acuity remained stable over a total observation period of 6 months.

Serous Macular Detachment Associated with Dome-Shaped Macula and Tilted Disc

“…Intravitreal injection of the antiangiogenic drug bevacizumab has failed to show efficacy in a recent report [6]. Therefore, observation is recommended in these unusual cases of SMD associated with DSM and tilted disc.…”

Spectral-domain optical coherence tomography findings in pediatric tilted disc syndrome

“…TDS must be differentiated from dysversion of the optic nerve head, which is characterized by the emergence of the central retinal vessels temporal to the vertical midline of the disc and by decreased visual acuity. The ophthalmic features of TDS in adult patients include a pronounced crescent, known as conus, of the inferior nasal aspect of the nerve and peripapillary area, thinning of the retinal pigment epithelium and choroid in the inferior nasal fundus that may be ophthalmoscopically visible as fundus depigmentation, myopia, and astigmatism [4][5][6][7][8]. In adult patients, TDS seems to be associated with visual field defect.…”

Analyses of shape of eyes and structure of optic nerves in eyes with tilted disc syndrome by swept-source optical coherence tomography and three-dimensional magnetic resonance imaging

“…A PubMed search using keywords 'tilted disc' and 'optical coherence tomography (OCT)' on 2 October 2012 extracted 13 articles. However, after excluding the myopic disc tilt, only seven studies examined TDS by OCT. [8][9][10][11][12][13][14] The purpose of OCT examination in six of these studies was limited to measuring the thickness of the peripapillary retinal nerve fiber layer or to analyzing the macular pathologies, for example, serous retinal detachment and choroidal neovascularization. It was not possible to observe the deeper structures within the optic nerve or the deeper tissues of the eye by conventional OCT.…”