A 70-year-old Black man with a history of hypertension and hyperlipidemia was referred for a vascular lesion on the optic nerve of the left eye. He was asymptomatic, with VA of 20/20 OD and 20/25 OS. The anterior segment was unremarkable in each eye. Fundus examination in the left eye revealed a prepapillary vascular loop without any abnormalities in the macula or peripheral retina (Main Figure). Fundus examination in the right eye was unremarkable.

Click to view larger

DISCUSSION

Prepapillary vascular loop is a congenital anomaly of the optic disc that presents as an elevated and twisted bundle of vessels projecting into the vitreous cavity. It is rare, with estimated incidence ranging from one in 2,000 to one in 9,000 eyes, although those numbers may be underestimated given that it is asymptomatic in most cases and is usually detected on routine fundus examination.1,2

Prepapillary vascular loops have rare association with branch retinal artery occlusion, amaurosis fugax, retinal microaneurysm, recurrent vitreous hemorrhage, subretinal hemorrhage, and hyphema.3 In asymptomatic cases such as this one, observation is recommended.

If you have an image or images you would like to share, email Manish Nagpal, MBBS, MS, FRCS, Section Editor, at drmanishnagpal@yahoo.com.

1. Mireskandari K, Aclimandos WA. Probably the longest prepapillary loop in the world. Retina. 2001;21(4):393-395.

2. Romano PE. Prepapillary vascular loops. Clin Exp Ophthalmol. 2001;29(2):90-91.

3. Akaiwa K, Mitamura Y, Katome T, Semba K, Egawa M, Naito T. Prepapillary vascular loops complicated by suspected macroaneurysm rupture. Case Rep Ophthalmol Med. 2014;2014:157242.