Título / Title

RETINAL FINDINGS IN DENSE DEPOSIT DISEASE - CASE REPORT

Introdução / Purpose

To report a clinical case of a 45-year-old patient with dense deposit disease (DDD) presenting drusen and possible choroidal neovascularization.

Material e Método / Methods

A case report.  

Resultados / Results

A 45-year-old male complained of two months decrease on visual acuity in both eyes (OU). He had kidney transplant in 2006 for chronic kidney disease secondary to dense deposit disease (DDD). The ophthalmologic examination revealed the visual acuity of 0.5 OU. Fundoscopy showed multiple and diffuse drusenoid lesions in OU. Additionally, he presented a circular lesion of two optic disc diameters in the left eye (OS) inferior temporal arcade (ITA). Fundus autofluorescence (FAF) demonstrated multiple circular lesions with varying hyperautofluorescence and hypoautofluorescence. Fluorescein angiography (FA) showed multiple areas with increasing hyperfluorescence in OU. Optical coherence tomography (OCT) revealed multiple drusenoid retinal pigmented epithelial detachments (PEDs) associated with the thickening of Bruch's membrane. Moreover, a heterogeneous PED, corresponding to the alteration seen in the OS ITA by funduscopy. This variation led to the diagnosis of nonexudative type I extramacular choroidal neovascularization (figures 1 and 2). The management was a proper ophthalmological follow-up.

Discussão e Conclusões / Conclusion

DDD is a rare kidney. Recently, it has been divided into two groups: complement and immune complex-mediated. Its incidence rate is 2-3 cases per 1 million inhabitants. Primarily, the diagnosis occurs between 5-15 years old. Regarding ophthalmological findings related to MPGN, the presence of drusen, of the basal lamina in young individuals stands out. Electron microscopy and histopathology reveal diffuse, focal, and electron-dense deposits in Bruch's membrane and choriocapillaris. Drusen under 50 is rare, and MPGN is a differential diagnosis. Other features in MPGN are Bruch's membrane thickening, serous retinal detachment, and choroidal neovascularization. Its pathophysiology is similar to AMD.

Palavras Chave

II membranoproliferative glomerulonephritis (MPNG); dense deposit disease (DDD); Age-related macular degeneration (AMD); Drusen.

Area

CLINICAL RETINA