First Author: J.Paz Moreno-Arrones SPAIN
Co Author(s): R. Jimenez parras
Purpose:
Acquired hyperopia with choroidal folds is an uncommon but well recognized condition that is often benign. Choroidal folds are quite difficult to recognize and are frequently over-passed, although they have a characteristic aspect at the fundus examination. They are not a diagnosis but a clinical sign, that may be idiopathic or in association with an ocular pathology. Recognizing them can orientate in establishing a certain diagnosis.
Setting:
Service of ophthalmology, principe de asturias university hospital, alcala de henares, madrid, spain.
Methods:
We report two patients of 29 and 50 years old presenting with unilateral choroidal folds in posterior segment in which, after a complete ophthalmic examination, we suspected an acquired hyperopic shift syndrome due to the flattening of the posterior pole of the affected eye, variable enlargement of the optic nerve complex, and a space between the optic nerve and its sheath. Fluorescein angiography and magnetic resonance imaging revealed a flattening of posterior globes and distended perineural subarachnoid spaces. This two cases are presented that shows the perineural space is best seen on magnetic resonance imaging. Lumbar puncture to exclude increased intracranial pressure should be performed even in the absence of papilloedema because pseudotumor cerebri needs to be definitively ruled out.Normal neuro-ophthalmological investigation including lumbar puncture may indicate an alternative cause.
Results:
Extensive ocular and extraocular investigation failed to uncover a specific etiology. Pseudotumor cerebri, a well-documented cause of papilledema and choroidal folds, was ruled out in each case. Each patient did demonstrate variable degrees of hyperopia and shortened axial lengths. Acquired hyperopia with choroidal folds is a benign condition characterised by the acute development of a unilateral or bilateral hyperopic shift in refractive error. We emphasize the importance of a differential diagnosis from a wide variety of disorders that can mimic this syndrome.
Conclusions:
We present here the main causes of choroidal folds, and a detailed description of their clinical aspects, hoping that this important clinical landmark will be more easier to recognize and interpret.The benign syndrome of acquired hyperopia with choroidal folds deserves emphasis in order to spare patients from unnecessary and potentially hazardous neurosurgical or orbital investigation. Idiopathic acquired hyperopia in middle-aged patients who are hyperopic with shortened axial lengths may be associated with choroidal folds and a constricted scleral canal causing optic disk congestion and complicated by nonarteritic anterior ischemic optic neuropathy due to a crowded disk. FINANCIAL DISCLOSURE?: No
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