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Year : 1982  |  Volume : 30  |  Issue : 3  |  Page : 129-132

White with pressure (WWP) and white without pressure (WWOP) lesions

Institute of Ophthalmology, Aligarh Muslim University, Aligarh, India

Correspondence Address:
Manoj Shukla
Institute of Ophthalmology, Aligarh
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Source of Support: None, Conflict of Interest: None

PMID: 7174054

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How to cite this article:
Shukla M, Anuja O P. White with pressure (WWP) and white without pressure (WWOP) lesions. Indian J Ophthalmol 1982;30:129-32

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Shukla M, Anuja O P. White with pressure (WWP) and white without pressure (WWOP) lesions. Indian J Ophthalmol [serial online] 1982 [cited 2021 Apr 17];30:129-32. Available from: https://www.ijo.in/text.asp?1982/30/3/129/28190

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The phenomenon of with white pressure (WWP) in which retinal opacification occurs in the peripheral retina on scleral indentation was first described by Schepens[1]. Okumara[2] coined the term `white with pressure' to describe a flat peripheral detachment without any retinal break. The condition of white without pressure (WWOP) has been described as an advan­ced form of white with pressure where a certain whitening of peripheral retina is apparent even without scleral indentation.[3],[4],[5] The pre sent investigation was undertaken to stud` these two important lesions of peripheral retina in normal Indian subjects and to fine out their association with retinal breaks.

  Materials and methods Top

The present study was undertaken on 400 eyes of 200 normal subjects who were picked up randomly from those attending the out­patients department and refraction units. These individuals ranged in age from 10 to 72 years and did not have any symptoms related to a retinal disease. Visual acuity and refrac­tive status of each individual was recorded.

The examination of peripheral retina was undertaken after a maximal pupillary dilatation by Fison's indentation indirect Ophthalmos­cope. It was further supplemented by poste­rior segment biomicroscopy with the help of a Goldmann's 3-mirror contact lens in eyes hav­ing peripheral retinal degenerations including white with pressure and white without pressure lesions. This examinations was undertaken to study the finer morphological details of these lesions and their relation with overlying poste­rior hyaloid membrane of the vitreous. The findings were recorded on a conventional fundus topography chart.

  Observations Top

The phenomenon of white with pressure was seen in the peripheral retina after scleral indentation and presented different shapes [Figure - 1] a. The affected retina appeared as an area of white opacification which significantly blurred the underlying choroidal pattern. The lesion was seen in 63 (15.75%) eyes of 44 (22%) subjects being bilateral in 19 (43.18%) of them. The phenomenon was more common in the second decade of life [Table - 1] without predilection for any sex (x2=0.16). The lesions of white with pres­sure were more commonly observed in myopic eyes as is clear from [Table - 2]. 50 (79.37%) eyes had islands of WWP located in the sub oral region while 10 (15.87%) of the affected eyes had the islands in the equatorial region. The remaining 3 (4.76%) eyes had WWP present in both the locations. In all 74 islands of white with pressure were observed out of which 62 (83.78%) islands were located in the sub oral region and 12 (16.22%) islands at the equator. These figures are exclusive of areas of white with pressure associated with cystoid and lattice degenerations. All the quadrants of the peripheral retina were affec­ted with white with pressure but temporal half of the retina was affected more than the nasal [Table - 3].

White without pressure (WWOP) lesion was observed in l I (2.7S%) eyes of 8 (4%) subjects being bilateral in (37.50%) of them. The retina looked thick and slightly opaque without any retinal detachment. In all instan­ces the lesions of WWOP affected equatorial and post equatorial regions being separated from ora serrata by white with pressure (WWP). Two subjects who happened to be brothers had 360° white without pressure [Figure - 1] b. 7 out of 11 affected eyes had a myopia of moderate to high degree (-3D to -16D). Temporal half of the retina was affec­ted more than the nasal. We did not observe occurrence of retinal breaks in areas of WWP and WWP although many such lesions had significant evidence of vitreo-retinal adhesion and traction.

  Discussion Top

The incidence of white with pressure (15.75%) as observed in our study is similar to that reported by Halpern[6]. While Rutnin and Schepens[3] observed the phenomenon in 31.9% of normal eyes. We did not observe any increase in the incidence of WWP with age as reported by Rutnin & Schepens[3] rather in our study the phenomenon tended to be more in the second decade of life. Our observation of predominantly sub oral location of white with pressure (WWP) support the observations of other workers[4],[7]. We did not however, find any post equatorial extension of WWP lesions as observed by Karlin & Curtin[4]. We observed a least incidence of WWP in supranasal quadrant while Rutnin and Schepens[3] observed that WWP lesions are least common in the inferonasal quadrant. Our finding of relation of WWP and WWOP with high myopia is consistent with the observations of Kirker and McDonald[8].

The phenomenon of white without pressure is an advanced form of white with pressure and may be quite extensive (360°). Its similar presentation in two brothers in our study points towards the role of some heredity fac­tors involved in the genesis of these lesions. We however, could not study the family mem­bers of other individuals having WWOP les­ions on account of unavailability.

Retinal breaks have been reported in the areas of white with pressure[4],[7] However, no such relation was seen in the present study although localised adhesions of posterior hya­loid membrane of the vitreous with advance WWP and WWP lesions was observed in fem instances. In view of vitreo-retinal adhesion and traction being present in such lesions, these, conditions are potentially dangerous as the3 may predispose to the development of retina breaks. As such these lesions merit careful follow up and if at any stage retinal breaks develop in these lesions, prophylactic treat­ment of such lesions should be undertaken.

  Summary Top

Two interesting lesions of peripheral retina­ white with pressure (WWP) and white without pressure (WWOP) were studied in 400 eyes of 200 normal subjects from general population. These lesions are frequently bilateral and affect 15.75% and 2.75% of normal eyes respectively. They are more commonly seen in highly myo­pic eyes of younger individuals in the sub oral and equatorial regions of temporal retinal peri­phery. Advanced lesions of WWP and WWOP exhibited vitreo-retinal adhesion and traction and as such no retinal breaks have been observed in these areas.

  References Top

Schepens, C.L., 1952, Trans. Amer. Acad. Ophthalmol. Otolaryngol., 56:399.  Back to cited text no. 1
Okiimara, I.D., 1953, Quoted by Karlin & Curtin; In Retina Congress, Appleton Century Crofts, New York; 1972, Page 630.  Back to cited text no. 2
Rutnin, U. and Schepens, C,L., 1967, Amer. J. Ophthalmol., 64:1040.  Back to cited text no. 3
Karlin, D.B, and Curtin, B.J., 1972, Axial length measurements in peripheral fund us changes in myopic eyes: In Retina Congress, Appleton Century Crofts, New York, 1972, p.p. 629.  Back to cited text no. 4
Watzke, R.C., 1974, An Experimental and histo­logic study of WWP-In current concepts in Ophthal­mology, Vol. 4, ed. by F.C. Blodi, 1974, p.p. 344.  Back to cited text no. 5
Halpern, J,L, 1966, Amer. J. Ophthalmol., 62:99.  Back to cited text no. 6
Watzke, R.C., 1961, Arch. Ophthalmol., 66:812.   Back to cited text no. 7
Kirker, G.E M. and McDonald, D J., 1971, Canad. J. Ophthalmol., 6:58.  Back to cited text no. 8


  [Figure - 1]

  [Table - 1], [Table - 2], [Table - 3]


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