DOI: 10.36347/sjmcr.2024.v12i01.013

Pages: 51-53

This report describes a case of unilateral myelinated retinal nerve fibers associated with ipsilateral myopia, amblyopia and exotropia. A 3-year-old boy presented with the complaint of diminished vision in his right eye. Visual acuity testing with a picture at a distance of 2.5 m revealed 1.5 in the left eye, but right visual acuity was not available. Near visual acuity with dot cards was 0.2 in the right eye and 0.6 in the left eye. The refractive error was -7.25D and +1.50D in the right and left eyes, respectively. Fundus examination revealed extensive myelinated retinal nerve fibers in the right eye, but no abnormal findings in the left eye. The axial length was 24.10 mm and 22.90 mm in the right and left eyes, respectively. Cycloplegic retinoscopy revealed a refractive error of a −7.00D in the right eye and plane in the left eye. Glasses with full optical correction were prescribed, and the patient was evaluated one month later, presenting a best-corrected visual acuity of 0.6 in the right eye and 2.0 in the left eye with a picture at a distance of 2.5 m. Three months later, his visual acuity was 0.7 in the right eye. At this point, amblyopia treatment was started with two hours daily of left eye occlusion. One year following the initial presentation, his visual acuity improved 0.8 in the right eye. The type of fixation, the initial visual acuity, the high myopia and the high anisometropia indicated a most likely bad prognosis. However, the age of diagnosis and wearing status of glasses were advantage for treatment effect in this case. Even though this condition is associated with poor visual prognosis, intensive occlusion therapy should always be attempted, along with the prescription of a cycloplegic refraction, due to unexpected and variable responses to treatment.