“White without Pressure” Associated with Other Degenerations: Features of Vitreoretinal Interface on OCT Scans (Clinical Case)

“White without pressure” warrants special attention from ophthalmologists due to the lack of consensus on its etiopathogenesis and associated risk of rhegmatogenous retinal detachment. “White without pressure” appears in various quadrants of the fundus as an area white to gray in color. It is more common in persons with high myopia.
The paper presents a clinical case of a 19-year-old male with an association between “white without pressure”, “dark without pressure”, vitreoretinal tuft and symptomatic floaters in the left eye. OCT scanning (SOLIX) was employed to assess the vitreoretinal interface. OCT revealed the intraretinal location of “white without pressure” and “dark without pressure” degenerations without vitreoretinal traction. “White without pressure” degeneration is hyperreflective at the level of the outer retina in the photoreceptor ellipsoid and myoid zones, and “dark without pressure” is hyporeflective at this level. Vitreoretinal tuft is a vitreoretinal degeneration located at the level of the inner limiting membrane. It was detected as a hyperreflective site with vitreoretinal adhesion leading to traction and thickening of the corresponding retinal area. The combination of the three degenerations poses a risk of rhegmatogenous retinal detachment due to the presence of the vitreoretinal tuft.

1. Nagpal KC, Goldberg MF, Asdourian G. Dark without pressure fundus lesions. Br J Ophthalmol. 1975;59:476–479. DOI: 10.1136/bjo.59.9.476

2. Salmon J, ed. Kanski’s clinical ophthalmology a systematic approach. 9th ed. Oxford: Elsevier; 2020.

3. Cheung R, Ly A, Katalinic P, Coroneo MT, Chang A, Kalloniatis M, Madigan MC, Nivison-Smith L. Visualisation of peripheral retinal degenerations and anomalies with ocular imaging. Semin Ophthalmol. 2022;37(5):554–582. DOI: 10.1080/08820538.2022.2039222

4. Peripheral retinal dystrophies. Optical coherence tomography. Laser coagulation of the retina: atlas / Edited by V.A. Shaimova. St. Petersburg: Chelovek, 2015. 240 p., ill. (In Russ.).

5. Shaimova VA., ed. Peripheral Retinal Degenerations. Optical Coherence Tomography and Retinal Laser Coagulation. 2nd ed. Cham: Springer International Publishing; 2017. DOI: 10.1007/978-3-319-48995-7

6. Jones WL. Developmental Anomalies, Degeneration, and Diseases of the Peripheral Retina and Pars Plana. In: Jones WL. ed. Peripheral Ocular Fundus, Butterworth-Heinemann, 2007:14–121. DOI: 10.1016/b978-0-7506-7505-5.50006-5

7. Bedi N., Punjabi S. Prevalence and characteristics of peripheral retinal degeneration in myopic indian adults International Journal of Current Research and Review. 2016;08(20):17–19.

8. Fawzi A, Nielsen J, Mateo-Montoya A, Somkijrungroj T, Li H, Gonzales J, Maugt-Faysse M, Jampol L. Multimodal imaging of white and dark without pressure fundus lesions. Retina. 2014;34(12):2376–2387. DOI: 10.1097/iae.0000000000000388

9. Sebag J. Vitreous: in health and disease. N.Y., Springer, 2014. 925 p.

10. Diaz RI, Sigler EJ, Randolph JC, Rafieetary MR, Calzada JI. Spectral domain optical coherence tomography characteristics of white without pressure. Retina. 2014;34(5):1020–1021. DOI: 10.1097/IAE.0000000000000012

11. Güler M. Regmatojen Retina Dekolmanı Riski Olan Periferik Retina Dejenerasyonları ve Tedavisi, Güncel Retina 2019;3(3):142–146. DOI: 10.37783/crj-0155

12. Chhablani J, Bagdi A. Peripheral retinal degenerations. Review: Assigned status Up to Date by Hyde RA on July 14, 2021. Eye Wiki. Accessed February 28, 2022. https://eyewiki.aao.org/w/index.php?title=Peripheral_Retinal_Degenerations&oldid=70838

13. Cheng SCK, Lam CSY, Yap, MKH. Prevalence of myopia related retinal changes among 12–18-year-old Hong Kong Chinese myopes. Ophthalmic Physiol Optics 2013;33:652–660. DOI: 10.1111/opo.12082

14. Choudhry N, Golding J, Manry M, Rao R. Ultra Widefield Steering Based Spectral-Domain Optical Coherence Tomography Imaging of the Retinal Periphery. Ophthalmology. 2016;123(6):1368–1374. DOI: 10.1016/j.ophtha.2016.01.045

15. Neroev VV, Zakharova GYu, Kondratyeva YuP Peripheral vitreoretinal degenerations in fellow eyes of patients with rhegmatogenous retinal detachment Russky Ofthalmologichesky Zhurnal, 2014;7(3):5–10 (In Russ.).