Bacillary layer detachment and its spontaneous resolution in central retinal vein occlusion

Raj S Hirawat; Nagesha C Krishnappa; Rashi T Sawal; Pratyusha Ganne

doi:10.4103/ijo.IJO_1623_21

PHOTO ESSAY

Year : 2022 | Volume : 2 | Issue : 1 | Page : 290-291

Bacillary layer detachment and its spontaneous resolution in central retinal vein occlusion

Raj S Hirawat¹, Nagesha C Krishnappa², Rashi T Sawal¹, Pratyusha Ganne³
¹ Department of Vitreo-Retina, Gomabai Netralaya, Neemach, Madhya Pradesh, India
² Department of Vitreo-Retina, B. W. Lions Eye Hospital, Bangalore, Karnataka, India
³ Department of Ophthalmology, All India Institute of Medical Sciences, Guntur, Andhra Pradesh, India

Date of Submission	11-Jun-2021
Date of Acceptance	27-Jul-2021
Date of Web Publication	07-Jan-2022

Correspondence Address:
Dr. Nagesha C Krishnappa
Department of Vitreo-Retina, B. W. Lions Superspeciality Eye Hospital, Bangalore, Karnataka
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_1623_21

Abstract

Keywords: Bacillary layer detachment, central retinal vein occlusion, macular edema, optical coherence tomography

How to cite this article:
Hirawat RS, Krishnappa NC, Sawal RT, Ganne P. Bacillary layer detachment and its spontaneous resolution in central retinal vein occlusion. Indian J Ophthalmol Case Rep 2022;2:290-1

How to cite this URL:
Hirawat RS, Krishnappa NC, Sawal RT, Ganne P. Bacillary layer detachment and its spontaneous resolution in central retinal vein occlusion. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Aug 14];2:290-1. Available from: https://www.ijoreports.in/text.asp?2022/2/1/290/334896

A 45-year-old man presented with sudden loss of vision in the left eye (LE) for 2 days. He had no known significant systemic illnesses. Best-corrected visual acuity in the right eye was 6/6, N6 and the LE was 1/60, N36. LE showed features suggestive of central retinal vein occlusion (CRVO) with gross macular edema [Figure 1]a. Optical coherence tomography (OCT) macula of the LE confirmed edema (Central macular thickness = 1520 um) with neurosensory detachment [Figure 1]b. On closer examination, a prominent split was noted in the myoid with a hyperreflective lesion under the fovea {Bacillary layer detachment (BLD)} which looked like a hanging lantern [Figure 1]b and [Figure 1]c His blood cell counts, coagulation profile, blood sugar, lipid profile, and homocystiene levels were normal. Blood pressure and renal profile was in normal range. He was planned intravitreal AntiVEGF therapy after baseline workup. BLD and neurosensory detachment (NSD) resolved spont aneous ly during the workup period and the vision improved to 6/60 without any intervention [Figure 1]d. He was kept under observation without intervention as the swelling appeared resolving further.

Figure 1: Composite picture showing (a) Color fundus photo of the left eye with central retinal vein occlusion and macular edema. (b) Horizontal optical coherence tomography (OCT) scan through center of the macula shows combined bacillary layer detachment (arrow) and neurosensory detachment. A hyperreflective lesion resembling a hanging lantern is noted under the fovea. (c) Scan through inferior parafoveal area shows detached ellipsoid zone (arrow head). (d) OCT scan at the end of 1 week showing resolution of edema, which makes the separation between the external limiting membrane and ellipsoid zone more distinct

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Discussion

The macular edema in CRVO is secondary to the accumulation of fluid in the interstitial space due to a sudden increase in intraluminal hydrostatic pressure within the venules. Recently, splitting in the myoid zone (or separation of external limiting membrane from the ellipsoid zone) has been described on OCT as BLD.^[1] This is secondary to hyperacute choroidal exudation or an inherent weakness in photoreceptor structure at the level of the myoid zone compared to the external limiting membrane and ellipsoid zone. A sudden increase in fluid pressure and shear stress caused by vigorous and sudden exudation from retinochoroidal layers has been proposed to result in such a split.^[2]

BLD has been mostly described in eyes with inflammatory conditions (APMPPE, tubercular granuloma, etc.) including ARMD.^{[2],[3],[4],[5]} Our case adds to the list of posterior segment diseases which can present with BLD. The present case demonstrates BLD occurrence and its dramatic resolution without any intervention.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Mehta N, Chong J, Tsui E, Duncan JL, Curcio CA, Freund KB, et al. Presumed foveal bacillary layer detachment in a patient with toxoplasmosis chorioretinitis and pachychoroid disease. Retin Cases Brief Rep 2018;15:391-8.
2.	Cicinelli MV, Giuffré C, Marchese A, Jampol LM, Introini U, Miserocchi E, et al. The bacillary detachment in posterior segment ocular diseases. Ophthalmol Retina 2020;4:454-6.
3.	Markan A, Aggarwal K, Gupta V, Agarwal A. Bacillary layer detachment in tubercular choroidal granuloma: A new optical coherence tomography finding. Indian J Ophthalmol 2020;68:1944-6. [PUBMED] [Full text]
4.	Kohli GM, Bhatia P, Shenoy P, Sen A, Gupta A. bacillary layer detachment in hyper-acute stage of acute posterior multifocal placoid pigment epitheliopathy: A case series. Ocul Immunol Inflamm 2020:1-4. doi: 10.1080/09273948.2020.1823423.
5.	Jung JJ, Soh YQ, Yu DJG, Rofagha S, Lee SS, Freund KB, et al. Bacillary layer detachment due to macular neovascularization. Retina 2021. doi: 10.1097/IAE.0000000000003153.