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EDITORIAL COMMENTARY
Year : 2021  |  Volume : 67  |  Issue : 1  |  Page : 6

Drusen-like deposits in systemic disorders: A point of convergence for nephrologists and ophthalmologists


Department of Retina and Vitreous Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India

Date of Submission21-Sep-2020
Date of Acceptance01-Oct-2020
Date of Web Publication09-Feb-2021

Correspondence Address:
S Sen
Department of Retina and Vitreous Services, Aravind Eye Hospital, Madurai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpgm.JPGM_1099_20

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How to cite this article:
Sen S. Drusen-like deposits in systemic disorders: A point of convergence for nephrologists and ophthalmologists. J Postgrad Med 2021;67:6

How to cite this URL:
Sen S. Drusen-like deposits in systemic disorders: A point of convergence for nephrologists and ophthalmologists. J Postgrad Med [serial online] 2021 [cited 2021 Feb 26];67:6. Available from: https://www.jpgmonline.com/text.asp?2021/67/1/6/309005




Drusen-like deposits (DLDs) have been described in multiple systemic diseases like membranoproliferative glomerulonephritis (MPGN) (dense deposit disease, C3 glomerulonephritis), including MPGN secondary to systemic lupus erythematosus (SLE), chronic inflammatory conditions like hepatitis B and C, and immunoglobulinemias.[1] Drusenoid deposits have also been reported in Alport syndrome, vitamin A deficiency, pseudoxanthoma elasticum, Sjogren-Larsson syndrome, Kjellin syndrome, and familial partial lipodystrophy.[1] DLDs in MPGN may develop at an earlier age than age-related macular degeneration (AMD), often in the second decade of life.[2] Although DLDs may not directly cause visual impairment, vision may be affected by macular detachment, central serous chorioretinopathy, or choroidal neovascularizati?on similar to patients with AMD.[3] Histologically, DLDs have been demonstrated to react with antibodies against C5, TIMP3, vitronectin, and amyloid P component, which are all hallmarks of AMD-associated drusen.[4] One study on SLE patients with or without nephropathy found that DLDs were detected in 40% of all SLE patients, with glomerulonephritis patients having more DLDs per eye, larger deposits, and DLDs in more than three quadrants.[5] Inflammation seems to be a common component in all these conditions, and complement alteration may be the primary cause of all these lesions.[5]

In this issue of the journal, Handa et al[6] have documented DLDs in a patient of multiple myeloma presenting with nephropathy, as a part of its inflammatory manifestations in the eye. Similar to drusen, the morphology and location of DLD can be accurately documented by optical coherence tomography (OCT), and they may be distinguished from drusen based on autofluorescence imaging, where unlike drusen, DLDs do not show hyper-autofluorescence. It can be inferred that any patient below the age of 50 demonstrating retinal drusen should be screened for renal disease at presentation and may be offered regular eye examinations. Moreover, a screening OCT may be performed in all patients presenting with glomerulonephritis, to detect the presence of drusen-like deposits.



 
 :: References Top

1.
Khan KN, Mahroo OA, Khan RS, Mohamed MD, McKibbin M, Bird A, et al. Differentiating drusen: Drusen and drusen-like appearances associated with ageing, age-related macular degeneration, inherited eye disease and other pathological processes. Prog Retin Eye Res 2016;53:70-106.  Back to cited text no. 1
    
2.
Duvall-Young J, MacDonald MK, McKechnie N. Fundus changes in (type 2) glomerulonephritis simulating drusen: A histological report. Br J Ophthalmol 1989;73:297-30.  Back to cited text no. 2
    
3.
Lent-Schochet D, Yiu G. Drusen in dense deposit disease: Not just age-related macular degeneration. Lancet 2020;395:1726.  Back to cited text no. 3
    
4.
Mullins RF. Genetic insights into the pathobiology of age-related macular degeneration. Int Ophthalmol Clin 2007;47:1-14.  Back to cited text no. 4
    
5.
Invernizzi A, dell'Arti L, Leone G, Galimberti D, Garoli E, Moroni G, et al. Drusen-like deposits in young adults diagnosed with systemic lupus erythematosus. Am J Ophthalmol 2017;175:68-76.  Back to cited text no. 5
    
6.
Handa S, Gupta V, Agarwal A. Drusen-like deposits in a patient with multiple myeloma. J Postgrad Med 2021;67:51-2.  Back to cited text no. 6
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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
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