Vitreoretinal Anomalies and Tufts

Introduction

Snowflake degenerations are small granular-like deposits which resemble snowflakes in the peripheral retina
- Has an AD inheritance pattern
- Vitreous degeneration and traction. Extends from the ora serrata as far as the equator, and overtime is associated with retinal vessel sheathing and RPE clumping and posterior border

Non-cystic tufts are short thin internal projections of the retina into the vitreous
- Present in 72% of people
- Is a benign finding, with a risk of RRD being 0.28%
- Tips of the tuft can break off to form floaters

Cystic tufts are round/oval grey/white elevations, often with a pigmented base
- 80% unilateral but typically stable
- Traction from mobile vitreous can cause changes in the tuft shape, causing a retinal break and RRD
- 10% RRD caused by tears originating from VR tufts.

Dead Giveaways

Snowflake Degeneration:

Primarily just the appearance of snowflakes of a whitish colour

Non-Cystic Tuft:

Fundus appearance and OCT appearance shown. Has a slightly dark appearance on fundus, and mixed hyper reflectivity internally.

Cystic Tuft:

Fundus appearance is a bit brighter compared to non-cystic, and on OCT, the tuft has cystic spaces internally, which appears hypo-reflective

diagnostic features

Snowflake Degeneration:

Can be associated with waxy optic disc pallor
Early onset cataracts
Corneal guttae
ERG can show increased dark adaptation, reduced scotopic B-wave, but unaffected photopic vision