Bacillary Layer Detachment in Diabetic Retinopathy: A Case Report

Abstract

To our knowledge, this is the first report to describe bacillary layer detachment (BLD) in a patient with diabetic retinopathy treated with anti-vascular endothelial growth factor. We present the case of a 55-year-old diabetic female who was referred to our hospital complaining of decreased vision in her left eye for 2 weeks. Fundus examination of both eyes was compatible with diabetic retinopathy. Spectral-domain optical coherence tomography of the left eye showed a large dome-shaped cystic space with marginal septa, splitting the myoid zone, consistent with the BLD phenotype. A single dose of intravitreal bevacizumab injection was administered. After 4 weeks, BCVA was improved significantly with complete resolution of BLD. Underlying choroidal ischemia in patients with different vascular disorders like diabetes mellitus may lead to photoreceptor stress and BLD. This study adds to the growing literature, which describes BLD as a marker of fluid accumulation in relation to several macular diseases.

Prevalence of bacillary layer detachment in diabetic macular edema and response to 3 anti-vascular endothelial growth factor treatment

“…In a recent case report by Amini et al also revealed a 55-year-old female with diabetic retinopathy was treated with a single dose of anti-VEGF and resulted in increased visual acuity and complete remission of BALAD. [ 23 ]…”

“…But we postulate that the improvement in visual acuity induced by regression of SRF markedly outweighs the decrease caused by BALAD and the formation of EZ/IZ disruption following BALAD resolution.Moreover, Amini et al documented progressive restoration of the EZ during long-term follow-up, which may also explain the improvement in visual function after BALAD remission. [ 23 ]…”

“…BALAD has been reported in various studies over the years, encompassing several case reports, case series, and retrospective studies spanning a spectrum of diseases, including toxoplasmosis chorioretinitis, [ 11 ] Vogt-Koyanagi-Harada disease, [ 12 ] neovascular macular degeneration, [ 13 ] acute idiopathic maculopathy, [ 14 ] central serious chorioretinopathy, [ 15 ] serpiginoid choroiditis, [ 16 ] blunt eye trauma with choroidal rupture, [ 17 ] posterior scleritis, [ 18 ] intraocular tuberculosis, [ 19 ] acute posterior multifocal placoid pigment epitheliopathy, [ 20 ] fungal endophthalmitis, [ 21 ] sympathetic ophthalmia, [ 22 ] and also DME. [ 23 ]…”