Optik Disk Drusen
Özet
Optik disk druseni (ODD), optik sinir başının prelaminer tabakasında yer alan, kalsifiye ve hyalin yapıda asellüler birikintilerle karakterize, çoğunlukla bilateral görülen bir anomalidir. Genellikle asemptomatik seyretse de zamanla yavaş ilerleyen arkuat gibi görme alanı defektlerine yol açabilir. Özellikle çocuklarda derin yerleşimli olanlar, nörolojik acil durumlar içeren papilödem ile karışabileceğinden ayırıcı tanı büyük önem taşır. Tanı ve ayırıcı tanıda B-tarama ultrasonografi (USG), fundus otofloresans (FOF), optik koherens tomografi (OKT), fundus fluorescein anjiografi (FFA) ve bilgisayarlı tomografi (BT) gibi yardımcı görüntüleme yöntemlerinden yararlanılır. OKT, papilödemdeki "düzgün kontur ve Lazy V" görünümüne karşın, ODD'deki "lumpy-bumpy" girintili çıkıntılı yapıyı ayırt etmede oldukça etkilidir. ODD; retina hemorajileri, santral retinal arter veya ven tıkanıklıkları, peripapiller koroidal neovaskülarizasyon ve en sık olarak da non-arteritik anterior iskemik optik nöropati (NAİON) gibi ciddi vasküler komplikasyonlara neden olabilir. Genel olarak benign karakterde bir hastalık olmasına rağmen, görmeyi tehdit edebilecek bu vasküler komplikasyonlar riski sebebiyle hastaların düzenli klinik takibi gereklidir.
Optic disc drusen (ODD) is a predominantly bilateral anomaly characterized by calcified, hyaline, acellular deposits located within the prelaminary layer of the optic nerve head. Although most patients remain asymptomatic regarding visual acuity, ODD can cause slowly progressive visual field defects over time, most commonly presenting as arcuate defects. Differential diagnosis is critical, particularly in children where deeply buried drusen can easily be misdiagnosed as papilledema, which is associated with various neurological emergencies. Advanced imaging modalities, including B-scan ultrasonography (USG), fundus autofluorescence (FAF), optical coherence tomography (OCT), fundus fluorescein angiography (FFA), and computed tomography (CT), are utilized to achieve an accurate diagnosis. OCT is highly effective in differentiation, distinguishing the "lumpy-bumpy" irregular inner contour of ODD from the smooth contour and "Lazy V" pattern characteristic of true papilledema. Furthermore, ODD can lead to significant vascular complications, such as retinal hemorrhages, central retinal artery or vein occlusions, peripapillary choroidal neovascularization, and most frequently, non-arteritic anterior ischemic optic neuropathy (NAION), which serves as the primary cause of vision loss in these patients. Consequently, while ODD is generally considered a benign condition, regular clinical follow-up is essential due to the potential risk of these vision-threatening complications.
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