Optociliary shunt vessels in multiple sclerosis

Abstract

Background/Introduction

Optociliary shunt vessels develop as a result of chronic retinal venous obstruction. Optic neuritis has never been reported as a causative influence.

Objective

To determine whether optic neuritis predisposes to the development of optociliary shunts in patients with multiple sclerosis.

Cases

This case series follows two patients with multiple sclerosis from August 1^st, 2019 to April 24^th, 2024, who developed optociliary shunt vessels after attacks of optic neuritis. A 43-year-old female presented with left visual loss and bilateral superior optociliary shunt vessels. Perimetry showed bilateral peripheral visual field loss. Optical coherence tomography showed bilateral retinal thinning and ganglion cell complex loss. Optical coherence tomography angiography showed reduced capillary density bilaterally. We investigated her and eventually diagnosed her with multiple sclerosis. The second, a 49-year-old female, developed right-sided optociliary shunt vessels after an episode of neuroretinitis. Perimetry revealed bilateral central scotomata; optical coherence tomography showed disc and retinal nerve fiber layer edema, and serous retinal detachment; later, ganglion cell complex loss; and reduced capillary density on optical coherence tomography angiography. Neuroimaging revealed demyelination in both, leading to a diagnosis of multiple sclerosis, and therapy was instituted.

Conclusions

We hypothesize, that demyelinating optic neuritis due to multiple sclerosis causes chronic retinal hypoperfusion, leading to subsequent optociliary shunt development in affected eyes. Our case series reveals that eyes with optic neuritis, both previous episodes and fresh cases, can contribute to sufficient retinal vein hypoperfusion to cause the development of optociliary shunts, which should be reported in the literature.

SUMMARY FOR SOCIAL MEDIA IF PUBLISHED

Does optic neuritis in multiple sclerosis cause optociliary shunt vessels? Our case study shows that optociliary shunt vessels have developed in eyes having previous as well as fresh optic neuritis in two multiple sclerosis patients, as demonstrated by examination and investigations. We hypothesize that multiple sclerosis causes decreased retinal perfusion predisposing to the development of optociliary shunts. This will guide neurologists and ophthalmologists in diagnosing this debilitating condition upon the visualization of optociliary shunts; heralding previous or recurrent attacks of optic neuritis. @SanaNadeemS

Keywords:

• Optociliary shunt vessels
• retinochoroidal veins
• visual loss
• multiple sclerosis
• optic neuritis
• visual field loss
• neuroretinitis

Authors’ contributions

Sana Nadeem: Conception and design of the study, acquisition and analysis of data and drafting a significant portion of the manuscript or figures. Aasma Nudrat Zafar: Radiological reporting and manuscript review.

Ethics approval

Ethical Committee of Fauji Foundation Hospital, affiliated with Foundation University Islamabad gave permission for publishing this research.

Consent to participate

Both patients have given written, informed consent to participate in our research.

Consent for publication

Both patients have given written, informed consent to sharing of their data and images for publication and educational purposes.

Synopsis

Optociliary shunts develop as a result of decreased retinal venous perfusion. We present two such cases in patients diagnosed with multiple sclerosis, and we believe these may be an association or consequence of this disease.

Key points

Question

Does optic neuritis in multiple sclerosis cause the formation of optociliary shunt vessels?

Findings

This case study shows that optociliary shunt vessels have developed in eyes with previous as well as fresh optic neuritis in two multiple sclerosis patients, as demonstrated by examination and investigations.

Meaning

Multiple sclerosis is associated with decreased retinal perfusion, predisposing to the development of optociliary shunts.

Significance statement

Optociliary shunts with visual loss should raise a red flag, and we should thoroughly investigate for a hidden, sinister cause. Multiple sclerosis may cause decreased retinal perfusion to predispose to the formation of these collateral vessels on the optic disc. Reporting our cases enlightens other clinicians to make appropriate diagnoses when they come across these findings on ocular examination.

Disclosure statement

The authors report no competing interests.

Additional information

Funding

No funding was received towards this work.