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Images in clinical medicine

Myelinated retinal nerve fiber layer: an extensive presentation

Myelinated retinal nerve fiber layer: an extensive presentation

Zeineb Kallel1,&, Malek Kharrat1

 

1Ophtalmology Department, Hospital of Mohamed Taher Maamouri, Nabeul, Tunisia

 

 

&Corresponding author
Zeineb Kallel, Ophtalmology Department, Hospital of Mohamed Taher Maamouri, Nabeul, Tunisia

 

 

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Myelinated retinal nerve fiber layer is rare. It is estimated to occur in 0.5% to 1% of the population and is often detected on routine examination without symptoms. It consists of white or gray-white well-demarcated patches on the outermost surface of the retina that obscure the underlying retinal vessels. It can be associated with axial myopia, amblyopia, and strabismus. A 12-year-old girl with normal development presented with ocular deviation of the right eye. There was no past medical or ocular history. Automatic refraction found in the right eye -9 DP and -1 DP in the left eye. The best Visual acuity was 20/600 in the right eye and 20/20 in the left one. Slit lamp examination of the right eye (A) revealed two vast whitish zones extending from the papilla towards the temporal sector sparing the posterior pole. These lesions covered the temporal vessels with fuzzy and scalloped boundaries. Fundus examination of the left eye was without abnormalities (B). Scan of Optical coherence tomography showed isolated hyper reflectivity of the fiber optic layer, an abnormality of the vitreoretinal interface with posterior shadow cone effect (C).

Figure 1: axial T1 (A,B) and coronal FLAIR sequences demonstrating rudimentary severely hypoplastic eyeballs (white arrows) and small slightly deformed extraocular muscles (yellow arrows) (C)