Optociliary shunt vessels in diabetes mellitus

Optociliary shunt vessels is classically described to be associated with optic nerve sheath meningioma, with the triad symptoms of optociliary veins, disc pallor and visual loss. Other clinical settings include retinal vein occlusion, chronic glaucoma, meningioma, and rarely as a congenital form. We report an interesting case series of three patients with diabetes mellitus presenting with optociliary shunts.

Patients who underwent diabetic retinopathy screening were referred to the eye clinic for abnormal findings. Between 2000 and 2001, out of a total of 3,360 patients, three diabetic patients with optociliary shunt vessels were found (0.1 percent). Optociliary shunt vessels were documented with fundus photography and fundal fluorescein angiography.

All three patients had bilateral mild nonproliferative diabetic retinopathy with one having, in addition, bilateral diabetic maculopathy. Fluorescein angiography showed classical features of acquired optociliary shunts with no leakage. Systemic review did not show any secondary cause of the optociliary shunts.

Our case series showed that optociliary veins can be associated with diabetes mellitus. The authors postulate that it may be due to venous insufficiency secondary to the process of diabetic microangiopathy and venous stasis.