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PHOTO ESSAY
Year : 2018  |  Volume : 66  |  Issue : 4  |  Page : 568-569

Floating venous loop in regressed retinopathy of prematurity


Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

Date of Submission04-Nov-2017
Date of Acceptance02-Jan-2018
Date of Web Publication26-Mar-2018

Correspondence Address:
Dr. Shreyas Temkar
Room No 123, Hostel RPC-1, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1017_17

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  Abstract 


Keywords: Retinopathy of prematurity, vascular loop, vitreous hemorrhage


How to cite this article:
Temkar S, Damodaran S, Chawla R, Behera S, Bafna RK, Parmanand K. Floating venous loop in regressed retinopathy of prematurity. Indian J Ophthalmol 2018;66:568-9

How to cite this URL:
Temkar S, Damodaran S, Chawla R, Behera S, Bafna RK, Parmanand K. Floating venous loop in regressed retinopathy of prematurity. Indian J Ophthalmol [serial online] 2018 [cited 2019 Oct 19];66:568-9. Available from: http://www.ijo.in/text.asp?2018/66/4/568/228457



Retinal vascular loops are uncommon malformations. Majority of them are congenital peripapillary loops and rarely acquired.[1],[2],[3] Often they are innocuous. Rarely, they can cause branch retinal artery occlusion, vitreous hemorrhage, or subretinal hemorrhage.[4],[5] We present a case of floating retinal venous loop in a case of regressed retinopathy of prematurity with associated vitreous hemorrhage.


  Case Report Top


A 7-year-old male child was brought with a history of diminution of vision in both eyes since childhood. There was a history of premature birth at 7.5 months with a birth weight of 1.5 kg. Best-corrected visual acuity (BCVA) was 6/18 in the right eye and positive perception of light in the left eye. Right eye fundus revealed media haze of 1+ with dispersed vitreous hemorrhage. The left eye had a closed funnel retinal detachment. Retcam (Clarity medical systems, Inc.,)-assisted imaging was performed under anesthesia using 130° wide field lens. A venous loop was noted in continuity with the superior venous arcade [Figure 1]a, confirmed on fluorescein angiography [Figure 1]b. This venous loop showed free movements within the vitreous cavity, easily appreciated with slight movements of the eyeball [Video 1]. Temporal avascular retina [Figure 1]b was also seen, but there was no evidence of active or regressed neovascularization. Scatter laser of the avascular retina was performed. There was complete resolution of vitreous hemorrhage at 6-week follow-up [Figure 1]c. BCVA was 6/9 with spectacle correction. The patient was advised close follow-up and to report immediately in case of sudden vision loss.
Figure 1: (a) Fundus image showing venous loop in continuity with the superior venous arcade. (b) Fluorescein angiography showing temporal avascular retina without any evidence of neovascularization. (c) Follow-up fundus image showing superotemporal venous loop and lasered temporal retina

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  Discussion Top


Embryologically, congenital vascular loops are postulated to arise due to aberrant misdirection of the growing retinal vasculature towards the Bergmeister's papilla instead of growing radially onto the retina.[6] Acquired venous loops have been reported in the setting of diabetic retinopathy, ocular hypertension, etc.[2],[3] The possible mechanism of their formation has been postulated to be gradual occlusion of a larger vein with the formation of collateral vessels, one or some of which enlarge and form a loop or reduplication.[2]

The exact pathogenesis of floating venous loop in our case is difficult to ascertain. We presume that an aberration in the angiogenesis and vascular progression in the course of retinopathy of prematurity associated with a localized malformation in the overlying internal limiting membrane is a possible mechanism.

In cases of congenital and acquired vascular loops, vitreous traction on the loop has been proposed as the possible cause of vitreous hemorrhage.[2] In our case also, direct traction on the bare vascular loop by the posterior hyaloid could have led to vitreous hemorrhage.


  Conclusion Top


Traction on the floating retinal vascular loop in a case of regressed retinopathy of prematurity can cause vitreous hemorrhage.

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 Top

1.
Degenhart W, Brown GC, Augsburger JJ, Magargal L. Prepapillary vascular loops. Ophthalmology 1981;88:1126-31.  Back to cited text no. 1
[PUBMED]    
2.
Bek T. Venous loops and reduplications in diabetic retinopathy. Prevalence, distribution, and pattern of development. Acta Ophthalmol Scand 1999;77:130-4.  Back to cited text no. 2
[PUBMED]    
3.
West RH, Cebon L, Grant G, Gillies WE. Solitary silent venous papillary loops and ocular hypertension. Aust J Ophthalmol 1984;12:351-7.  Back to cited text no. 3
[PUBMED]    
4.
Singh R, Fujinami K, Moore AT. Branch retinal artery occlusion secondary to prepapillary arterial loop. Retin Cases Brief Rep 2014;8:124-6.  Back to cited text no. 4
[PUBMED]    
5.
Fujiwara T, Machida S, Herai T, Tazawa Y. Case of subretinal hemorrhage that developed from a prepapillary vascular loop. Jpn J Ophthalmol 2004;48:175-7.  Back to cited text no. 5
[PUBMED]    
6.
Mireskandari K, Aclimandos WA. Probably the longest prepapillary loop in the world. Retina 2001;21:393-5.  Back to cited text no. 6
[PUBMED]    


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