IMAGES & VIDEOS: Drusen in systemic argyrosis seen on scanning laser ophthalmoscopy

Abstract

A 67-year-old woman with systemic argyrosis presented at the ophthalmology clinic at Centre Hospitalier Intercommunal de Créteil with myodesopsia and photopsia. On examination, her best-corrected visual acuity was 20/25 in the right eye and 20/20 in the left eye. Slit-lamp examination was normal apart from grayish conjunctival discoloration. Fundus examination revealed a large pattern of shiny deposits surrounding the posterior pole of both eyes. Retro-mode imaging with the Mirante scanning laser ophthalmoscope (Nidek; Gamagori, Japan) yielded distinct observations of drusenoid deposits. As its annular aperture diverges laterally from the illumination path established by the confocal aperture, the device gathers backscattered light from a specific direction while obstructing light from other directions. The scattered light that traverses through the deflected aperture casts a shadow on the abnormal features, thereby augmenting their contrast and definition. The appearance of lesion shadows varies depending on the laterality of the annular aperture, with both right-deviated (DR) and left-deviated (DL) annular apertures. In DL position, extensive drusenoid deposits were visible on the right and left eyes, whereas in right illumination, these deposits were no longer discernible.