Bergmeister papilla - Retina Club : Retina Club

Figure 1. Remnant of hyaloid artery

Figure 2. Color retinography of the right eye. Prepapillary glial proliferation extending to the macular area

Figure 3. Color retinography of the left eye. Mild prepapillary glial proliferation.

Figure 4. Prepapillary glial proliferation of the OD in OCT

Figure 5. Prepapillary glial proliferation of the LE in OCT

Figure 6. Extension of prepapillary glial proliferation to the macular area

Figure 7. Macular cube. Epiretinal glial proliferation with macular thickening

Figure 8. Prepapillary glial proliferation in en face image of the OD

Description

Bergmeister’s papilla (BP) is considered a remnant of the persistent hyaloid artery at the level of the optic disc, and appears as an epipapillary membrane that can occlude the papilla or part of it. It is usually unilateral and without clinical repercussions, often being a chance finding. The embryonic hyaloid artery, a branch of the primitive dorsal ophthalmic artery, is responsible for irrigating the lens during embryonic development and is progressively reduced from the tenth week of gestation until it disappears at birth. The incomplete disappearance of these embryonic structures on the head of the optic nerve causes the permanence of glial tissue at the beginning of the Cloquet canal or Stilling duct that connects the optic nerve with the lens, crossing the vitreous humor and which would be the complete remnant of the hyaloid artery.

Comments

Indication

A 48-year-old male presented for a routine ophthalmologic check-up. Examination revealed corrected visual acuity of one in both eyes. Biomicroscopic examination revealed the presence of a remnant of the hyaloid artery in the right eye (RE) (Figure 1) and Mittendorf's point in the posterior capsule of the lens, while examination of the anterior segment of the left eye (LE) was normal. Funduscopic examination revealed the presence of a bilateral Bergmeister papilla, with a large prepapillary glial proliferation in the RE that extends to the macular area (Figure 2), with very mild prepapillary proliferation in the left eye (Figure 3). Optical Coherence Tomography (OCT) showed a prepapillary hyperreflective image compatible with glial proliferation (Figures 4 and 5) and extension of this proliferation to the macular area in the right eye (Figure 6), leading to thickening of the macular thickness (Figure 7). The en face papillary image of the RE shows glial proliferation (Figure 8).