Stages of Acutely Symptomatic Macular Holes

ization and peripapillary hemorrhage,3,4 but none had optic disk drusen. It is hypothesized that the cause of the disk edema may be infiltration of the optic nerve or nerve sheath with lymphoid cells, or autoantibodies produced by plasma cells or lymphoid cells may deposit within the nerves of the body, thus, inducing a neuropathy and optic disk edema. Patients with POEMS syndrome may have increased serum levels of vascular endothelial growth factor. Vascular endothelial growth factor may play a role in the development of choroidal neovascularization. Peripapillary choroidal neovascularization has been de-scribed in association with optic disk drusen.5 The origin is not completely understood. Enlarging optic nerve drusen may impair the circulation to the peripapillary retina. The consequent retinal ischemia may then stimulate the growth of new vessels beneath the pigment epithelium. Alternatively, enlargement or anterior migration of optic nerve drusen may allow the ingrowth of vessels through this discontinuity, disrupting the integrity of the Bruch membrane. The most common ocular finding in patients with POEMS syndrome is optic disk edema. The possibility of optic disk drusen and peripapillary choroidal neovascular-ization should be considered in patients with vision loss and POEMS syndrome