Myelinated nerve fiber layer associated with other ocular pathology in a 20-year-old myopic man

Abstract

Background: Myelinated retinal nerve fibers (MRNFs) are usually unilateral and asymptomatic benign lesions associated with mild hypermetropia, emmetropia, or severe myopia. We describe herein an myopic patient with a syndrome of ipsilateral myelinated retinal nerve fibers associated with other pathological changes: epiretinal membrane with pseudohole, vitreomacular traction syndrome and bilateral lattice degeneration.Methods: Extended ophthalmoscopy was used to evaluate retinal posterior segment. Infrared reflectance imaging helped in visualizing sub-retinal pathology. Detailed images from within the retina were obtained by using optical coherence tomography.Results: Ophthalmologic examination revealed ipsilateral small temporal myopic conus with lattice degeneration temporally and inferotemporally. The area of myelinated nerve fiber extended into the pappilomacular bundle, but did not reach the fovea. At the fovea, an epiretinal membrane with clinically visible vitreomacular traction and some retinal elevation was found. In the peripheral fundus areas of lattice degeneration temporally and inferiorly was also noted. The OCT scans of the affected eye showed an incomplete posterior vitreous detachment with traction of a thickened posterior hyaloid base to the fovea. There was distortion of the foveal anatomy with a small amount of subfoveal fluid but a full-thickness macular hole could not be detected. Macular traction detachment of retina and epiretinal membrane with macular hole were treated surgically (S/P Repair Complex RD (25g, 20% SF6, membrane peel with gas endotamponade) and vitreomacular traction was released. Lattice degeneration was treated by laser (S/P Laser).Conclusions: MRNF lesions were stable and although associated with other ocular pathology progression was not observed during follow-up.