Bergmeister's papilla is a remnant of which embryological structure?

The fibrous sheath of the fetal hyaloid artery Bergmeister's papilla is a remnant of the fibrous sheath that surrounded the fetal hyaloid artery during development of the eye.

The embryonic fissure of the optic cup

The primitive epithelial papilla of the lens

The neural crest of the anterior chamber angle

In the reported case of Bergmeister's papilla with type 1 sialidosis, which finding explained the bilateral visual loss?

Bilateral macular cherry-red spots Fundus examination showed a macular cherry-red spot in both eyes with diffuse mid-peripheral pigment epithelial dystrophy; the Bergmeister's papilla was a unilateral incidental finding.

The Bergmeister's papilla itself

Incipient cortical lens opacities

Diffuse corneal endothelial opacity

At approximately what gestational age is the fetal hyaloid blood supply normally resorbed?

Around 30 weeks During normal development at around 30 weeks of gestational age this fetal blood supply is resorbed, leaving Cloquet's canal behind.

Resorption of the fetal hyaloid vessel normally leaves behind which structure?

Cloquet's (hyaloid) canal The resorbed hyaloid blood supply develops into Cloquet's canal, also called the hyaloid canal, running through the vitreous.

Incomplete resorption of the fetal hyaloid system also produces which other finding?

A Mittendorf dot Incomplete resorption of these fetal structures results in persistent fetal vasculature, of which the Mittendorf dot and Bergmeister's papilla are examples.

Which imaging modality is most likely to identify a Bergmeister's papilla?

Optical coherence tomography Bergmeister's papilla can be seen on ophthalmoscopy and fundus photography, but it is more likely to be identified on optical coherence tomography.

What does a Bergmeister's papilla look like on examination of the optic nerve head?

A pigmented crescent at the temporal disc margin

A deep excavation of the inferotemporal disc

A ring of hard exudate around the disc

What effect can a Bergmeister's papilla have on the optic nerve head?

It can influence the size of the optic cup The presence of these papillae can influence the size of the optic nerve head cup, which matters when assessing the disc.

It causes progressive optic atrophy

It produces disc oedema with venous congestion

It tilts the disc into an oblique insertion

When a Bergmeister's papilla is vascularized by a retinal vessel, what is that called?

A prepapillary vascular loop A papilla carrying a retinal vessel is known as a prepapillary vascular loop and can be shown on fluorescein angiography; without vascularization the angiogram is unremarkable.

What management does a Bergmeister's papilla require when no complications are present?

No treatment is indicated Bergmeister's papilla is typically asymptomatic and found incidentally, so no treatment is indicated when there are no associated complications.

Pars plana vitrectomy with membrane peel

YAG laser disruption of the glial tissue

Long-term topical anti-inflammatory therapy

Bergmeister’s papilla: case presentation, description and management

CASE REPORT

A 28-year-old woman suffering from type 1 sialidosis, underwent a complete ophthalmological assessment at the eye clinic complaining of a progressive decline of visual acuity in recent months.

Polymerase chain reaction (PCR) and Sanger sequencing analysis of the NEU1 gene disclosed an already described compound heterozygosity. The patient suffered from myoclonic epilepsy with hypotonia and severe motor disability, from approximately the age of 13 years.

The best corrected visual acuity (BCVA) measured with the Early Treatment Diabetic Retinopathy Study (ETDRS) chart at 2 m was: 45 letters (20/63) in the right eye (OD) and 33 letters (20/100) in the left eye (OS).

Slit lamp examination showed a slight diffuse opacity of the corneal endothelium in both eyes, with incipient lens cortical opacities. There was no nystagmus.

Fundus examination and retinography performed with True Color confocal ophthalmoscope EIDON, showed a macular cherry-red spot bilaterally, with diffuse dystrophy of the retinal pigment epithelium in the middle periphery.

In the right eye the optic disc was normal, while in the left eye, on the nasal portion of the optic disc, there was a whitish area of vitreous thickening, residual from the fetal vascularization on the optic disc ” Bergmeister’s papilla”.

DISEASE

Bergmeister’s papilla was first reported by Dr. Otto Bergmeister in 1877. Also referred to as an epipapillary veil, it is a remnant of the fibrous sheath surrounding the fetal hyaloid artery during embryological development.

In the fetus, blood is supplied to various parts of the eye by the hyaloid artery, which travels through the optic nerve head to the posterior aspect of the lens, where it branches into the tunica vasculosa lentis.

During normal development at around 30 weeks of gestational age, this blood supply is resorbed and develops into Cloquet’s (hyaloid) canal. Incomplete resorption of these structures during development can result in persistent fetal vasculature, such as the Mittendorf dot and the Bergmeister’s papilla.

It is suspected that defects in genes guiding cell apoptosis result in persistent fetal vasculature.

Test your knowledge 10 questions from this article

Symptoms

Bergmeister’s papilla is typically asymptomatic and found incidentally, changes to vision would depend upon association with secondary effects on the retina or macula.

Diagnostic procedures

Bergmeister’s papilla can be observed with ophthalmoscopy and fundus photography, but they are more likely to be identified through optical coherence tomography (OCT). Visualization reveals a cluster of veil-like glial or fibroglial tissue emerging anteriorly, centrally, and nasally from the optic nerve head.

The presence of papillae can influence the size of the optic nerve head cup. Bergmeister’s papilla can be unilateral or bilateral.

Papillae can be vascularized by a retinal vessel, otherwise known as a prepapillary vascular loop. If it is vascularized, this can be visualized on fluorescein angiography (FA). Without vascularization, the FA of a patient with Bergmeister’s papilla would be unremarkable.

MANAGEMENT

None indicated if Bergmeister’s papilla are without associated complications.

REFERENCES

Bergmeister O. Beiträge zur Entwicklungsgeschichte des Säugethierauges. Wien Embryologische Institut Mitteilungen. 1877;1:63-84.
Royal Society of London. B. In: Catalogue of Scientific Papers (1800-1883) Supplementary Volume. Vol XII. Cambridge, UK: Cambridge University Press; 1902:72.
Orellana J, Friedman AH. Bergmeister’s Papilla. In: Clinico-Pathological Atlas of Congenital Fundus Disorders. New York, New York: Springer; 1993:107-108. doi:10.1007/978-1-4613-9320-7_20
Goldberg MF. Persistent fetal vasculature (PFV): An integrated interpretation of signs and symptoms associated with persistent hyperplastic primary vitreous (PHPV). Am J Ophthalmol. 1997;124(5):587-626. doi:10.1016/s0002-9394(14)70899-2
Petersen HP. Persistence of the Bergmeister papilla with glial overgrowth. Acta Ophthalmol. 2009;46(3):430-440. doi:10.1111/j.1755-3768.1968.tb02826.x
Lin Q, Deng J, Ohno-Matsui K, He X, Xu X. The existence and regression of persistent Bergmeister’s papilla in myopic children are associated with axial length. Transl Vis Sci Technol. 2021;10(13):4. doi:10.1167/tvst.10.13.4.

Test yourself

A few questions straight from this article.

1 / 10 0 correct

Bergmeister's papilla is a remnant of which embryological structure?
Bergmeister's papilla is a remnant of the fibrous sheath that surrounded the fetal hyaloid artery during development of the eye.
In the reported case of Bergmeister's papilla with type 1 sialidosis, which finding explained the bilateral visual loss?
Fundus examination showed a macular cherry-red spot in both eyes with diffuse mid-peripheral pigment epithelial dystrophy; the Bergmeister's papilla was a unilateral incidental finding.
At approximately what gestational age is the fetal hyaloid blood supply normally resorbed?
During normal development at around 30 weeks of gestational age this fetal blood supply is resorbed, leaving Cloquet's canal behind.
Resorption of the fetal hyaloid vessel normally leaves behind which structure?
The resorbed hyaloid blood supply develops into Cloquet's canal, also called the hyaloid canal, running through the vitreous.
Incomplete resorption of the fetal hyaloid system also produces which other finding?
Incomplete resorption of these fetal structures results in persistent fetal vasculature, of which the Mittendorf dot and Bergmeister's papilla are examples.
Which imaging modality is most likely to identify a Bergmeister's papilla?
Bergmeister's papilla can be seen on ophthalmoscopy and fundus photography, but it is more likely to be identified on optical coherence tomography.
What does a Bergmeister's papilla look like on examination of the optic nerve head?
Visualization reveals a cluster of veil-like glial or fibroglial tissue emerging anteriorly, centrally and nasally from the optic nerve head.
What effect can a Bergmeister's papilla have on the optic nerve head?
The presence of these papillae can influence the size of the optic nerve head cup, which matters when assessing the disc.
When a Bergmeister's papilla is vascularized by a retinal vessel, what is that called?
A papilla carrying a retinal vessel is known as a prepapillary vascular loop and can be shown on fluorescein angiography; without vascularization the angiogram is unremarkable.
What management does a Bergmeister's papilla require when no complications are present?
Bergmeister's papilla is typically asymptomatic and found incidentally, so no treatment is indicated when there are no associated complications.