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Bosa López ME, Barraso Rodriguez M, Bennis S. Multimodal imaging in acute annular outer retinopathy: A case report. J Fr Ophtalmol 2024; 47:104086. [PMID: 38342725 DOI: 10.1016/j.jfo.2024.104086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 11/03/2023] [Indexed: 02/13/2024]
Affiliation(s)
- M E Bosa López
- Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Plaça Dr. Robert N(o) 5, 08221 Terrassa, Barcelona, Spain.
| | - M Barraso Rodriguez
- Hospital Sant Joan de Déu Barcelona, Universitat de Barcelona, Pg. de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - S Bennis
- Centre d'ophtalmologie La Ville Verte, Casablanca, Morocco
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Cicinelli MV, Ramtohul P, Marchese A, Bandello F, Bailey Freund K, Miserocchi E, Jampol LM. Latest advances in white spot syndromes: New findings and interpretations. Prog Retin Eye Res 2023; 97:101207. [PMID: 37574123 DOI: 10.1016/j.preteyeres.2023.101207] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023]
Abstract
White spot syndromes (WSS) pose challenges in the field of ophthalmology, particularly in terms of accurate diagnosis and effective management. However, recent advancements in multimodal imaging (MMI) have significantly contributed to our understanding of WSS, allowing for improved characterization of these inflammatory chorioretinopathies. By employing various imaging modalities, including fundus fluorescein angiography, indocyanine green angiography, fundus autofluorescence, optical coherence tomography (OCT), ultra-widefield imaging, and OCT angiography, researchers and clinicians have gained valuable insights into the underlying pathophysiological changes and clinical progression of WSS. Furthermore, MMI has unveiled novel and atypical variants within the spectrum of WSS, expanding our knowledge in this field. Notably, the identification of secondary forms of WSS occurring concurrently with unrelated chorioretinal disorders has suggested a potential autoimmune mechanism underlying these conditions. The introduction of MMI has also facilitated a more comprehensive evaluation of previously ill-defined entities, such as acute zonal occult outer retinopathy, leading to improved diagnostic criteria and enhanced recognition of distinct features. This review paper provides a comprehensive overview of the latest advances and interpretations in WSS. By integrating MMI into the diagnosis and management of these conditions, this review aims to enhance patient outcomes and provide valuable insights into the complexities surrounding WSS.
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Affiliation(s)
- Maria Vittoria Cicinelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Prithvi Ramtohul
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; NYU Grossman School of Medicine, New York, NY, USA
| | - Alessandro Marchese
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; NYU Grossman School of Medicine, New York, NY, USA
| | - Elisabetta Miserocchi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lee M Jampol
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Thenappan A, Nanda A, Lee CS, Lee SY. Retinitis Pigmentosa Masquerades: Case Series and Review of the Literature. J Clin Med 2023; 12:5620. [PMID: 37685687 PMCID: PMC10489117 DOI: 10.3390/jcm12175620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
Retinitis pigmentosa (RP) displays a broad range of phenotypic variations, often overlapping with acquired retinal diseases. Timely recognition and differentiation of RP masquerades is paramount due to the treatable nature of many such conditions. This review seeks to present examples of pseudo-RP cases and provide a comprehensive overview of RP masquerades. We first present two pseudo-RP cases, including comprehensive clinical histories and multimodal retinal imaging, to highlight the important role of accurate diagnoses that subsequently steered effective intervention. Subsequently, we conduct an in-depth review of RP masquerades to provide valuable insights into their key distinguishing features and management considerations. The recent approval of ocular gene therapy and the development of investigational gene-based treatments have brought genetic testing to the forefront for RP patients. However, it is important to note that genetic testing currently lacks utility as a screening tool for inherited retinal diseases (IRDs), including RP. The integrity of a precise clinical assessment remains indispensable for the diagnosis of both RP and RP masquerade conditions, thereby facilitating prompt intervention and appropriate management strategies.
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Affiliation(s)
- Abinaya Thenappan
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Arjun Nanda
- College of Medicine, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
| | - Chang Sup Lee
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Sun Young Lee
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- USC Ginsburg Institute for Biomedical Therapeutics and Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
- Department of Physiology, University of Oklahoma Health Science Center, Oklahoma City, OK 73104, USA
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Lin BR, Russell JF, Al-Khersan H, Goldhardt R. A systematic review of acute zonal occult outer retinopathy with a focus on attempted treatment modalities. CURRENT OPHTHALMOLOGY REPORTS 2022; 10:168-178. [PMID: 36742288 PMCID: PMC9894323 DOI: 10.1007/s40135-022-00305-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 12/05/2022]
Affiliation(s)
- Benjamin R. Lin
- Department of Ophthalmology, Bascom Palmer Eye Institute; Miami, Florida
| | - Jonathan F. Russell
- Department of Ophthalmology and Visual Sciences, University of Iowa; Iowa City, Iowa
| | - Hasenin Al-Khersan
- Department of Ophthalmology, Bascom Palmer Eye Institute; Miami, Florida
| | - Raquel Goldhardt
- Department of Ophthalmology, Bascom Palmer Eye Institute; Miami, Florida
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Milovanova E, Fielden MP, Kassam F. Acute zonal occult outer retinopathy in a patient with retinitis pigmentosa. Digit J Ophthalmol 2022; 28:58-63. [PMID: 36405442 PMCID: PMC9635758 DOI: 10.5693/djo.02.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A 30-year-old woman with a phenotypic presentation of retinitis pigmentosa (RP) presented with a 5-day history of painless, acute vision loss in her right eye, with visual acuity dropping from 20/30 to hand motions. Optical coherence tomography of the right macula showed near-complete loss of the ellipsoid layer. Treatment with a prolonged course of oral prednisone resulted in a complete structural regeneration of the ellipsoid layer and improvement of visual acuity to 20/50, with eccentric fixation. Tests for infectious diseases, autoimmune disorders, and rare RP mimic syndromes (eg, Refsum disease) were negative. The patient has remained stable since. We favor a diagnosis of two separate pathologies and suggest a designation of acute zonal occult outer retinopathy (AZOOR) in RP for this previously unreported presentation.
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Affiliation(s)
| | - Michael P. Fielden
- Calgary Retina Consultants, Calgary, Alberta;,Division of Ophthalmology, Department of Surgery, University of Calgary
| | - Faazil Kassam
- Calgary Retina Consultants, Calgary, Alberta;,Correspondence: Dr. Faazil Kassam, #200, 5340 1 Street SW, Calgary, Alberta, T2H 0C8 ()
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Paraneoplastic ocular syndrome: a pandora's box of underlying malignancies. Eye (Lond) 2021; 36:1355-1367. [PMID: 34345027 DOI: 10.1038/s41433-021-01676-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 06/28/2021] [Indexed: 02/06/2023] Open
Abstract
Paraneoplastic syndromes affecting the visual system are a group of conditions that arise in the systemic malignancy framework. In this review, we have provided a detailed and comprehensive overview of the published literature on the various ophthalmic paraneoplastic manifestations. A systematic review of many databases has been performed to identify ample literature on the paraneoplastic syndromes related to ophthalmology. We have discussed here the clinical features, pathogenesis, and treatment strategies of various ophthalmic paraneoplastic syndromes. It can be challenging to distinguish these disorders from their non-paraneoplastic counterparts and to determine the appropriate systemic assessment for the tumour responsible, to have a proper approach towards the management of the syndrome. METHOD: We searched PubMed, Science Direct and Journal of Ophthalmology for studies published in English between 1995 and April 2020, incorporating the general search term "paraneoplastic ocular syndrome" with connecting terms relevant to subheadings-e.g. Key search terms were cancer-associated retinopathy, (CAR), melanoma-associated retinopathy, (MAR), paraneoplastic retinopathy, autoimmune retinopathy, autoimmune-related retinopathy, and optic neuropathy, (ARRON), acute zonal occult outer retinopathy, (AZOOR), paraneoplastic vitelliform maculopathy, paraneoplastic vitelliform retinopathy, bilateral diffuse uveal melanocytic proliferation, (BDUMP), paraneoplastic optic neuropathy, (PON), polyneuropathy, organomegaly, endocrinopathy, monoclona gammopathy, and skin changes syndrome (POEMS) and various other terms. References from identified studies have been reviewed and included if deemed appropriate, valid, and scientifically important. If referenced in a selected English paper, we contemplated papers in other languages too. We preferentially selected papers that have been published in the last 10 years, but we have included relevant older references.
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Diagnostic and Therapeutic Challenges. Retina 2021; 41:1780-1785. [PMID: 33323899 DOI: 10.1097/iae.0000000000003027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Suzuki T, Kaburaki T, Tanaka R, Shirahama S, Komae K, Nakahara H, Takamoto M, Kawashima H, Aihara M. Incidence and changing patterns of uveitis in Central Tokyo. Int Ophthalmol 2021; 41:2377-2388. [PMID: 34047908 DOI: 10.1007/s10792-021-01791-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/06/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE The patterns of uveitis in Tokyo have recently changed due to advances in examination tools. We aimed to investigate the changes in the patterns of uveitis between 2004-2015 and 2016-2018. METHODS We retrospectively reviewed the data of 732 patients who visited the Uveitis Clinic at the University of Tokyo Hospital between January 2016 and December 2018. Background characteristics, laboratory results, and imaging findings were analysed. We compared the incidences of uveitis in 2016-2018 and 2004-2015 to identify changes in the patterns. RESULTS The most frequent diagnoses were sarcoidosis (8.9%), herpetic iridocyclitis (6.7%), intraocular lymphoma (5.5%), Vogt-Koyanagi-Harada disease (4.8%), unclassified acute anterior uveitis (4.6%), Behçet's disease (4.5%), bacterial endophthalmitis (2.9%), and Posner-Schlossman syndrome (2.6%). Suspected sarcoidosis (20.9%) was the most common cause of unclassified uveitis. The incidence of intraocular lymphoma was significantly higher in 2016-2018 than in 2004-2015. Between 2004 and 2018, herpetic iridocyclitis, bacterial endophthalmitis, and juvenile chronic iridocyclitis exhibited an increasing trend, and the incidences of Posner-Schlossman syndrome, unclassified acute anterior uveitis, Behçet's disease, and Vogt-Koyanagi-Harada disease exhibited a decreasing trend. CONCLUSION The changing patterns of uveitis were characterised by increases in the incidence of intraocular lymphoma. This may be attributed to recent advances in examination tools, the changes in the referred patient population, and the aging Japanese population.
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Affiliation(s)
- Takafumi Suzuki
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Ophthalmology, Shinseikai Toyama Hospital, Toyama, 939-0243, Japan
| | - Toshikatsu Kaburaki
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. .,Department of Ophthalmology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma, Ohmiya-ku, Saitama, Saitama, 330-8503, Japan.
| | - Rie Tanaka
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shintaro Shirahama
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Keiko Komae
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hisae Nakahara
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Mitsuko Takamoto
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hidetoshi Kawashima
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Makoto Aihara
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Comparison of clinical characteristics in patients with acute zonal occult outer retinopathy according to anti-retinal antibody status. Graefes Arch Clin Exp Ophthalmol 2021; 259:2967-2976. [PMID: 33876277 DOI: 10.1007/s00417-021-05198-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/19/2021] [Accepted: 04/09/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate the clinical characteristics of patients with acute zonal occult outer retinopathy (AZOOR), according to the presence or absence of anti-retinal antibodies (ARAs) that are frequently detected in autoimmune retinopathy. METHODS Retrospective observational case series. This study included 33 patients with acute-stage AZOOR who had been followed up for more than 6 months after the initial visit. The median follow-up period was 26 months. Immunoblot analyses were used to detect autoantibodies for recoverin, carbonic anhydrase II, and α-enolase in serum from these patients. Main outcome measures comprised clinical factors at the initial and final visits, including best-corrected visual acuity, mean deviation on Humphrey perimetry, and retinal morphology, which were statistically compared between patients with AZOOR who exhibited ARAs and those who did not. RESULTS At least one serum ARA was detected in 42% of patients with AZOOR. There were no significant differences in clinical factors between the two groups, including follow-up period, best-corrected visual acuity and mean deviation at the initial and final visits, a-wave amplitude on single-flash electroretinography at the initial visit, and frequencies of improvement of the macular ellipsoid zone and AZOOR recurrence. CONCLUSIONS Our findings suggest that the presence of ARAs did not influence visual outcomes or outer retinal morphology in patients with AZOOR.
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Abstract
This chapter reviews common applications of visual electrophysiology relevant to neuro-ophthalmology practice. The use of standard tests and extended protocols are described including the cortical visual evoked potential and pattern and full-field electroretinogram (PERG; ERG) methods, the latter including the photopic negative response. Abnormalities of these recordings are rarely specific but provide valuable diagnostic guidance and an objective measure of visual pathway function, difficult or impossible to infer by other methods. The electrophysiological phenotypes associated with Leber hereditary optic neuropathy, OPA1- and SSBP1-associated dominant optic atrophy, and WFS1-related syndromes are described. Typical changes in retinal and optic nerve function tests associated with acquired disease are highlighted, including those related to demyelination, ischemic, compressive, nutritional and toxic, and nonorganic etiologies. The importance of complementary testing using different electrophysiological techniques is emphasized, for the purposes of differential diagnosis and in disorders that may masquerade as optic nerve pathology.
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Affiliation(s)
- Neringa Jurkute
- UCL Institute of Ophthalmology, University College London, London, United Kingdom; Genetics Department, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Anthony G Robson
- UCL Institute of Ophthalmology, University College London, London, United Kingdom; Department of Electrophysiology, Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom.
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Shimada Y, Horiguchi M, Tanikawa A. Unilaterally extinguished electroretinograms in an eye with normal visual acuity and visual field. Doc Ophthalmol 2020; 142:127-132. [PMID: 32588162 DOI: 10.1007/s10633-020-09779-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 06/15/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE This study reports a case of unilateral retinopathy with extinguished full-field ERGs (ffERGs), wherein the visual acuity was 16/16 and the visual field was spared. METHODS Observational case report. RESULTS A 39-year-old female had developed nyctalopia in her left eye. Two years later, she visited an ophthalmologist who noted a bilaterally reduced pigmentation of the fundus. Her best-corrected visual acuity was 16/16 in both the eyes. Goldmann perimetry demonstrated that her visual field was bilaterally fully spared. ffERGs measurement was performed in accordance with the ISCEV standard protocol and indicated that her right eye was normal. However, all ERG responses were severely attenuated in her left eye. Multifocal ERG responses were found to be normal in the right eye and extinguished in the left eye except for residual responses that were exclusively located at the center. During the 7 years of the follow-up period, the visual field in the left eye, which was once normal, became shaded, and the development of a ring scotoma was identified. The visual field in the right eye is still full. CONCLUSIONS The pathogenesis of this patient's condition still remains unknown, while unilateral retinitis pigmentosa, unilateral pigmentary retinopathy, acute zonal occult outer retinopathy, and autoimmune retinopathy can all be considered as possible explanations. The uniqueness of this case study is that the extinguished ERG responses are predictive of the functional alteration in the affected eye, when the initial visual acuity and the visual field were normal.
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Affiliation(s)
- Yoshiaki Shimada
- Department of Ophthalmology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Masayuki Horiguchi
- Department of Ophthalmology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Atsuhiro Tanikawa
- Department of Ophthalmology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
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Kaye R, De Salvo G. A case report of acute zonal occult outer retinopathy. Eur J Ophthalmol 2019; 29:27-31. [PMID: 31282209 DOI: 10.1177/1120672119853143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To describe the diagnostic complexities of a patient with acute zonal occult outer retinopathy. CASE REPORT A healthy female presented with acute bilateral visual field loss and photopsia. On initial examination, her visual acuity, colour vision, fundus examination and fluorescein angiography were normal. Fundus autofluorescence, however, revealed scattered hyperautofluorescence in both eyes and electrodiagnostic tests were abnormal. A differential diagnosis including acute zonal occult outer retinopathy was postulated and serology requested. The patient's past medical history included both breast and endometrial cancer and raised the possibility of cancer-associated retinopathy. A normal full-body positron emission tomography scan, negative antibodies for cancer-associated retinopathy and abnormal electroretinogram led to a diagnosis of acute zonal occult outer retinopathy. CONCLUSION It has been more than 20 years since Gass first described the syndrome of acute zonal occult outer retinopathy. Typically affecting young, healthy females, acute zonal occult outer retinopathy is characterised by photopsia, minimal fundoscopic changes and electroretinographic abnormalities. Visual field loss is permanent and often associated with slow-progressing degeneration of the retinal pigment epithelial cells. Retinal photoreceptor dysfunction is an uncommon and unrecognised cause of acute visual loss. Acute zonal occult outer retinopathy should be considered as a differential diagnosis in those patients with deceptively normal fundal examinations, abnormal electroretinograms and visual field loss.
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Affiliation(s)
- Rebecca Kaye
- Ophthalmology Department, Southampton General Hospital, Southampton, UK
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Errera M, Robson AG, Wong T, Hykin PG, Pal B, Sagoo MS, Pavesio CE, Moore AT, Webster AR, MacLaren RE, Holder GE. Unilateral pigmentary retinopathy: a retrospective case series. Acta Ophthalmol 2019; 97:e601-e617. [PMID: 30597758 DOI: 10.1111/aos.13981] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 11/01/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To review the clinical characteristics and address the aetiology in a group of patients presenting with unilateral retinal pigmentary changes, best described as unilateral pigmentary retinopathy (UPR). METHODS The cohort of 42 patients was identified retrospectively from the Moorfields Eye Hospital electrophysiology database. All had undergone full-field [electroretinography (ERG)] and pattern electroretinography (PERG), with 13 additionally having multifocal ERG (mfERG). The clinical findings, fundus photographs and fundus autofluorescence (AF) images were reviewed. RESULTS All index eyes showed ERG evidence of generalized photoreceptor dysfunction with most showing a similar degree of rod and cone involvement. However, although the fellow eyes all had a normal fundus examination, there were bilateral but asymmetrical ERG abnormalities in eight patients and a further four patients had PERG evidence of macular dysfunction in the fellow eye. A relevant medical history or the diagnosis of an ophthalmologic entity that might be related to the unilateral fundus changes was ascertained in 15 cases (~36%) including acute zonal occult outer retinopathy, trauma, systemic malignancy or autoimmune disease, retinal vasculitis, presumed pregnancy-related choroidal ischaemia and meningitis. Two patients had a family history of retinitis pigmentosa (RP; 4.8%). CONCLUSION The underlying aetiology in most cases of UPR cannot accurately be identified, but an heritable cause is unlikely. Aspects of the history clearly suggest an acquired disorder in some patients. Twenty-five patients (60%) with nongenetic UPR did not adhere to the pattern of rod greater than cone dysfunction that occurs in RP (rod-cone dystrophy), and the pattern of rod > cone dysfunction seen in true RP is thus not a feature of most patients with UPR.
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Affiliation(s)
- Marie‐Hélène Errera
- Moorfields Eye Hospital London UK
- Quinze‐Vingts National Ophthalmology Hospital DHU Sight Restore. CIC 1423 Sorbonne‐Universités UPMC Université ParisFrance
| | - Anthony G. Robson
- Moorfields Eye Hospital London UK
- Institute of Ophthalmology University College London UK
| | | | - Philip G. Hykin
- Moorfields Eye Hospital London UK
- Institute of Ophthalmology University College London UK
| | - Bishwanath Pal
- Moorfields Eye Hospital London UK
- Institute of Ophthalmology University College London UK
| | - Mandeep S. Sagoo
- Moorfields Eye Hospital London UK
- Institute of Ophthalmology University College London UK
| | - Carlos E. Pavesio
- Moorfields Eye Hospital London UK
- Institute of Ophthalmology University College London UK
| | - Anthony T. Moore
- Moorfields Eye Hospital London UK
- Institute of Ophthalmology University College London UK
| | - Andrew R. Webster
- Moorfields Eye Hospital London UK
- Institute of Ophthalmology University College London UK
| | - Robert E. MacLaren
- Oxford University Hospitals NHS Foundation Trust UK. Nuffield Department of Clinical Neurosciences John Radcliffe Hospital Oxford UK
| | - Graham E. Holder
- Moorfields Eye Hospital London UK
- Institute of Ophthalmology University College London UK
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15
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Shirahama S, Kaburaki T, Nakahara H, Tanaka R, Takamoto M, Fujino Y, Kawashima H, Aihara M. Epidemiology of uveitis (2013-2015) and changes in the patterns of uveitis (2004-2015) in the central Tokyo area: a retrospective study. BMC Ophthalmol 2018; 18:189. [PMID: 30068311 PMCID: PMC6090933 DOI: 10.1186/s12886-018-0871-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 07/26/2018] [Indexed: 01/16/2023] Open
Abstract
Background The distribution of uveitis varies with genetic, ethnic, geographic, environmental, and lifestyle factors. Epidemiological information about the patterns of uveitis is useful when an ophthalmologist considers the diagnosis of uveitis. Therefore, it is important to identify the causes of uveitis over the years in different regions. The purposes of this study were to characterize the uveitis patients who first arrived at the University of Tokyo Hospital in 2013–2015, and to analyze the changes in the patterns of uveitis from 2004 to 2012 to 2013–2015. Methods We retrospectively identified 750 newly arrived patients with uveitis who visited the Uveitis Clinic in the University of Tokyo Hospital between January 2013 and December 2015, using clinical records. We extracted data on patient age, sex, diagnosis, anatomic location of inflammation, laboratory test results of blood and urine, and chest X-ray and fluorescein fundus angiography findings for each patient. In addition, we compared these data with those from 2004 to 2012 to analyze the changes in the patterns of uveitis. Results A definite diagnosis was established in 445 patients (59.3%). The most common diagnoses were herpetic iridocyclitis (7.5%), sarcoidosis (6.1%), Behçet’s disease (4.4%), Vogt–Koyanagi–Harada disease (4.1%), and intraocular lymphoma (4.1%). The most frequent unclassified type of uveitis was suspected sarcoidosis (22.3%). Analysis of the changes in the patterns of uveitis in the central Tokyo area from 2004 to 2012 to 2013–2015 revealed notable increasing trends of herpetic iridocyclitis and intraocular lymphoma, and increasing trends of bacterial endophthalmitis, fungal endophthalmitis, and juvenile chronic iridocyclitis. In contrast, the frequency of sarcoidosis, Behçet’s disease, and Vogt–Koyanagi–Harada disease decreased. Conclusions The patterns of uveitis changed considerably from 2004 to 2012 to 2013–2015. Continuous investigations about the epidemiology of uveitis are needed to diagnose uveitis more accurately.
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Affiliation(s)
- Shintaro Shirahama
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Toshikatsu Kaburaki
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hisae Nakahara
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Rie Tanaka
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Mitsuko Takamoto
- Department of Ophthalmology, Saitama Red Cross Hospital, 1-5 Shintoshin, Chuo-ku, Saitama-shi, Saitama, 330-8553, Japan
| | - Yujiro Fujino
- Department of Ophthalmology, Tokyo Shinjuku Medical Center, 5-1 Tsukudo-cho, Shinjuku-ku, Tokyo, 162-8543, Japan
| | - Hidetoshi Kawashima
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-City, Tochigi, Japan
| | - Makoto Aihara
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Wang M, Sadaka A, Prager T, Lee AG, Pellegrini F, Cirone D, De Simone L, Cimino L. From A… to… Z(OOR): The Clinical Spectrum of Acute Zonal Occult Outer Retinopathy. Neuroophthalmology 2018; 42:215-221. [PMID: 30042791 PMCID: PMC6056215 DOI: 10.1080/01658107.2017.1400076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 10/10/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022] Open
Abstract
Acute idiopathic blind spot enlargement (AIBSE) is often caused by Acute Zonal Occult Outer Retinopathy (AZOOR), an outer retinal disease. We report two illustrative cases of AZOOR. The first one was a 21-year-old white female who presented with a scotoma and "shimmering lights" in her left eye. In the second case, a 73-year-old white female was referred for evaluation of a "bitemporal hemianopsia" that started years prior, with no clinical significant photopsias. To our knowledge, case two is the longest documented duration of bilateral, progressive, and chronic, idiopathic, enlargement of the blind spot (CIBSE) documented in the English language ophthalmic literature.
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Affiliation(s)
- Margaret Wang
- Blanton Eye Institute, Department of Ophthalmology, The Methodist Hospital, Houston, Texas, USA
| | - Ama Sadaka
- Department of Ophthalmology, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Thomas Prager
- Blanton Eye Institute, Department of Ophthalmology, The Methodist Hospital, Houston, Texas, USA
| | - Andrew G Lee
- Blanton Eye Institute, Department of Ophthalmology, The Methodist Hospital, Houston, Texas, USA
- Department of Ophthalmology, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, Houston, Texas, USA
- Department of Ophthalmology, The University of Texas Medical Branch, Galveston, Texas, USA
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Francesco Pellegrini
- Neuro-Ophthalmology Service, Department of Ophthalmology, De Gironcoli Hospital, Conegliano, TV, Italy
| | - Daniele Cirone
- Uveitis Service, Department of Ophthalmology, Murri Hospital, Fermo, FM, Italy
| | - Luca De Simone
- Department of Ophthalmology, University Campus Bio-Medico of Rome, Rome, RM, Italy
- Immunology Eye Unit, Azienda USL IRCCS, Reggio Emilia, RE, Italy
| | - Luca Cimino
- Immunology Eye Unit, Azienda USL IRCCS, Reggio Emilia, RE, Italy
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ULTRA-WIDE-FIELD FUNDUS AUTOFLUORESCENCE FINDINGS IN PATIENTS WITH ACUTE ZONAL OCCULT OUTER RETINOPATHY. Retina 2018; 37:1104-1119. [PMID: 27755372 DOI: 10.1097/iae.0000000000001311] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE To determine whether ultra-wide-field fundus autofluorescence (UWFFAF) findings in acute zonal occult outer retinopathy correlated well with perimetry, optical coherence tomography, and electroretinography findings. METHODS Retrospective observational study on 16 eyes of 10 subjects with AZOOR seen at a single referral center from October 2012 to March 2015 who had UWFFAF performed. Chi-square analysis was performed to compare categorical variables, and Mann-Whitney U test used for comparisons of nonparametric continuous variables. RESULTS All eyes examined within 3 months of symptom onset (five of the five eyes) had diffusely hyperautofluorescent areas on UWFFAF. The remaining eyes contained hypoautofluorescent lesions with hyperautofluorescent borders. In 11/16 (68.8%) eyes, UWFFAF showed the full extent of lesions that would not have been possible with standard fundus autofluorescence centered on the fovea. There were 3 patterns of spread: centrifugal spread (7/16, 43.8%), centripetal spread (5/16, 31.3%), and centrifugal + centripetal spread (4/16, 25.0%). The UWFFAF lesions corresponded well with perimetric, optical coherence tomography, and electroretinography abnormalities. CONCLUSION The UWFFAF along with optical coherence tomography can be useful in the evaluation and monitoring of acute zonal occult outer retinopathy patients.
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Kuo YC, Chen N, Tsai RK. Acute Zonal Occult Outer Retinopathy (AZOOR): a case report of vision improvement after intravitreal injection of Ozurdex. BMC Ophthalmol 2017; 17:236. [PMID: 29207977 PMCID: PMC5718015 DOI: 10.1186/s12886-017-0638-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 11/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AZOOR was first described by Gass in 1993 as a syndrome with rapid loss of one or more extensive zones of the outer retinal segments. It is characterized by photopsia, minimal funduscopic changes, and electroretinographic abnormalities. The efficacy of systemic steroids in treating AZOOR has been previously described and advocated by the concept of autoimmune retinopathy. However, the use of intravitreal of sustained-released steroid had not been mentioned to date. CASE PRESENTATION A 34-year-old man had sudden onset of central scotoma and photopsia in the left eye. His visual acuity continued deteriorating. The visual field defect demonstrated bilateral enlarged blind spots and altitudinal defects. Fluorescein angiography (FA) showed nonspecific retinal inflammation, and an electroretinogram (ERG) illustrated decreased amplitude of the b wave in both eyes. Optical coherence tomography (OCT) examinations revealed parafoveal loss of the photoreceptor inner/outer segment (IS/OS) junction. Therefore, acute zonal occult outer retinopathy (AZOOR) was diagnosed. Although his vision did not improve under the initial treatment of systemic corticosteroid and calcium channel blocker, remarkable improvement was noticed after the intravitreal injection(IVI) of Ozurdex, consistent with the recovered IS/OS junction disruption. CONCLUSIONS We herein report a typical case of AZOOR, suggesting that the intravitreal injection of steroid may benefit in certain patients.
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Affiliation(s)
- Yi Chun Kuo
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Nancy Chen
- Department of Ophthalmology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Rong Kung Tsai
- Institute of Eye Research, Buddhist Tzu Chi General Hospital, Tzu Chi University, 707, Sec. 3, Chung-Yang Rd., Hualien, 970, Taiwan. .,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
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19
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Boudreault KA, Schuerch K, Zhao J, Lee W, Cabral T, Yannuzzi LA, Tsang SH, Sparrow JR. Quantitative Autofluorescence Intensities in Acute Zonal Occult Outer Retinopathy vs Healthy Eyes. JAMA Ophthalmol 2017; 135:1330-1338. [PMID: 29075777 PMCID: PMC5846132 DOI: 10.1001/jamaophthalmol.2017.4499] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Acute zonal occult outer retinopathy (AZOOR) remains a challenging diagnosis. Early recognition of the disease depends on advances in imaging modalities that can improve phenotyping and contribute to the understanding of the underlying pathogenesis. Objectives To expand the range of approaches available to assist in the identification of AZOOR by multimodal imaging and to analyze the fundus lesions by quantifying short-wavelength fundus autofluorescence (quantitative fundus autofluorescence [qAF]) and spectral-domain optical coherence tomography. Design, Setting, and Participants In this observational study, patients underwent imaging at Columbia University Medical Center between November 2010 and March 2016 and were analyzed between September 2015 and August 2016. Six patients diagnosed as having AZOOR were studied by qAF and spectral-domain optical coherence tomography and were compared with 30 age and race/ethnicity–matched controls from a database of 277 healthy control eyes. Main Outcomes and Measures In unaffected regions of the macula, qAF was calculated within predetermined circularly arranged segments (qAF8). In addition, qAF was measured within specified regions of interest positioned at the autofluorescent lesion border (AZOOR line). Electroretinograms and electro-oculograms were recorded in 5 of 6 patients. Results Among 6 patients (age range, 26-61 years; 4 female; 4 of white race/ethnicity, 1 Asian, and 1 Hispanic), 5 exhibited an autofluorescent AZOOR line in short-wavelength fundus autofluorescence images, delineating the peripapillary lesion. The mean (SD) region-of-interest qAF measured on the AZOOR line was 60 (26) times higher than in healthy control eyes (P = .03) at equivalent fundus locations. The qAF8 within nondiseased macular regions were within the normal range. At the lesion border, spectral-domain optical coherence tomography revealed a loss of outer retinal integrity in all patients. Single-flash cone b-wave latency and 30-Hz flicker latency responses were significantly delayed bilaterally. Lesions with smooth, homogeneous borders exhibited only minimal expansion in size over time, while the lesion in a patient with a heterogeneous border progressed more rapidly. Conclusions and Relevance The finding that qAF is elevated at the border between diseased and nondiseased retina in patients with AZOOR contributes to the understanding of the natural history of the disease.
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Affiliation(s)
| | - Kaspar Schuerch
- Department of Ophthalmology, Columbia University, New York, New York
| | - Jin Zhao
- Department of Ophthalmology, Columbia University, New York, New York
| | - Winston Lee
- Department of Ophthalmology, Columbia University, New York, New York
| | - Thiago Cabral
- Department of Ophthalmology, Columbia University, New York, New York
| | | | - Stephen H Tsang
- Department of Ophthalmology, Columbia University, New York, New York
- Department of Pathology and Cell Biology, Columbia University, New York, New York
| | - Janet R Sparrow
- Department of Ophthalmology, Columbia University, New York, New York
- Department of Pathology and Cell Biology, Columbia University, New York, New York
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Acute Zonal Occult Outer Retinopathy Associated With Retrobulbar Optic Neuritis. J Neuroophthalmol 2017; 37:287-290. [DOI: 10.1097/wno.0000000000000494] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Aleman TS, Sandhu HS, Serrano LW, Traband A, Lau MK, Adamus G, Avery RA. Acute Zonal Cone Photoreceptor Outer Segment Loss. JAMA Ophthalmol 2017; 135:487-490. [PMID: 28384671 DOI: 10.1001/jamaophthalmol.2017.0451] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The diagnostic path presented narrows down the cause of acute vision loss to the cone photoreceptor outer segment and will refocus the search for the cause of similar currently idiopathic conditions. Objective To describe the structural and functional associations found in a patient with acute zonal occult photoreceptor loss. Design, Setting, and Participants A case report of an adolescent boy with acute visual field loss despite a normal fundus examination performed at a university teaching hospital. Main Outcomes and Measures Results of a complete ophthalmic examination, full-field flash electroretinography (ERG) and multifocal ERG, light-adapted achromatic and 2-color dark-adapted perimetry, and microperimetry. Imaging was performed with spectral-domain optical coherence tomography (SD-OCT), near-infrared (NIR) and short-wavelength (SW) fundus autofluorescence (FAF), and NIR reflectance (REF). Results The patient was evaluated within a week of the onset of a scotoma in the nasal field of his left eye. Visual acuity was 20/20 OU, and color vision was normal in both eyes. Results of the fundus examination and of SW-FAF and NIR-FAF imaging were normal in both eyes, whereas NIR-REF imaging showed a region of hyporeflectance temporal to the fovea that corresponded with a dense relative scotoma noted on light-adapted static perimetry in the left eye. Loss in the photoreceptor outer segment detected by SD-OCT co-localized with an area of dense cone dysfunction detected on light-adapted perimetry and multifocal ERG but with near-normal rod-mediated vision according to results of 2-color dark-adapted perimetry. Full-field flash ERG findings were normal in both eyes. The outer nuclear layer and inner retinal thicknesses were normal. Conclusions and Relevance Localized, isolated cone dysfunction may represent the earliest photoreceptor abnormality or a distinct entity within the acute zonal occult outer retinopathy complex. Acute zonal occult outer retinopathy should be considered in patients with acute vision loss and abnormalities on NIR-REF imaging, especially if multimodal imaging supports an intact retinal pigment epithelium and inner retina but an abnormal photoreceptor outer segment.
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Affiliation(s)
- Tomas S Aleman
- Scheie Eye Institute at the Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia2Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania3Department of Ophthalmology, University of Pennsylvania, Philadelphia
| | - Harpal S Sandhu
- Scheie Eye Institute at the Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia
| | - Leona W Serrano
- Scheie Eye Institute at the Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia
| | - Anastasia Traband
- Scheie Eye Institute at the Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia
| | - Marisa K Lau
- Scheie Eye Institute at the Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia
| | - Grazyna Adamus
- Ocular Immunology Laboratory, Casey Eye Institute, Oregon Health and Science University, Portland
| | - Robert A Avery
- Scheie Eye Institute at the Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia2Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania3Department of Ophthalmology, University of Pennsylvania, Philadelphia
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ACUTE ZONAL OCCULT OUTER RETINOPATHY: Structural and Functional Analysis Across the Transition Zone Between Healthy and Diseased Retina. Retina 2017; 38:118-127. [PMID: 28590963 DOI: 10.1097/iae.0000000000001513] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess structure and function across the transition zone (TZ) between relatively healthy and diseased retina in acute zonal occult outer retinopathy. METHODS Six patients (6 eyes; age 22-71 years) with acute zonal occult outer retinopathy were studied. Spectral-domain optical coherence tomography, fundus autofluorescence, near-infrared reflectance, color fundus photography, and fundus perimetry were performed and images were registered to each other. The retinal layers of the spectral-domain optical coherence tomography scans were segmented and the thicknesses of two outer retinal layers, that is, the total receptor and outer segment plus layers, and the retinal nerve fiber layer were measured. RESULTS All eyes showed a TZ on multimodal imaging. On spectral-domain optical coherence tomography, the TZ was in the nasal retina at varying distances from the fovea. For all eyes, it was associated with loss of the ellipsoid zone band, significant thinning of the two outer retinal layers, and in three eyes with thickening of the retinal nerve fiber layer. On fundus autofluorescence, all eyes had a clearly demarcated peripapillary area of abnormal fundus autofluorescence delimited by a border of high autofluorescence; the latter was associated with loss of the ellipsoid zone band and with a change from relatively normal to markedly decreased or nonrecordable visual sensitivity on fundus perimetry. CONCLUSION The results of multimodal imaging clarified the TZ in acute zonal occult outer retinopathy. The TZ was outlined by a distinct high autofluorescence border that correlated with loss of the ellipsoid zone band on spectral-domain optical coherence tomography. However, in fundus areas that seemed healthy on fundus autofluorescence, thinning of the outer retinal layers and thickening of the retinal nerve fiber layer were observed near the TZ. The TZ was also characterized by a decrease in visual sensitivity.
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Abstract
PURPOSE To evaluate the electrooculogram (EOG) in a large series of patients with Best disease and autosomal recessive bestrophinopathy. METHODS A retrospective review of consecutive cases at Moorfields Eye Hospital, London, United Kingdom. Patients with Best disease or autosomal recessive bestrophinopathy who, after electrophysiologic testing, had a normal or atypical EOG light rise were identified. Main outcome measure was EOG amplitude, clinical phenotype and genotype. RESULTS One hundred thirteen patients were identified with likely disease-causing sequence variants in BEST1 (99 Best disease and 14 autosomal recessive bestrophinopathy). Electrooculograms had been performed in 75 patients. Twenty patients (27%) had no detectable light rise (Arden ratio of 100%) and 49 (65%) had Arden ratios of between 100% to 165%. Six patients (8%) were found to have an EOG light rise of >165%. No cases demonstrated significant interocular asymmetry in EOG amplitude. CONCLUSION The current work provides significant clinical evidence that the EOG phenotype in Best disease and autosomal recessive bestrophinopathy is more variable than currently appreciated. As a normal EOG may occur in the presence of a classical fundus appearance, the consequences of BEST1 mutation may be independently expressed, possibly mediated through differential effects on intracellular calcium homeostasis.
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Prevalence of Antiretinal Antibodies in Acute Zonal Occult Outer Retinopathy: A Comprehensive Review of 25 Cases. Am J Ophthalmol 2017; 176:210-218. [PMID: 27993590 DOI: 10.1016/j.ajo.2016.12.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 12/05/2016] [Accepted: 12/07/2016] [Indexed: 11/23/2022]
Abstract
PURPOSE To perform a comprehensive review and to investigate the presence and role of autoimmune antibodies in 25 cases of acute zonal occult outer retinopathy (AZOOR) identified using the classification originally proposed by J. Donald Gass. DESIGN Observational case series. METHODS Setting: Institutional. STUDY POPULATION Twenty-five patients were identified by characteristic symptoms (abrupt onset of photopsias, followed by large scotomata at or connected to the blind spot), ocular findings (paucity of pigmentary changes with no sign of vitreous inflammation and abnormal electroretinogram in at least 1 eye), and a negative family history for retinitis pigmentosa. OBSERVATION PROCEDURES Patients underwent a full comprehensive ophthalmologic examination, fundus retinography, Goldmann kinetic visual field (GVF), and full-field electroretinogram (ffERG). Blood samples were also obtained to verify for the presence of antiretinal antibodies by Western blot analysis. MainOutcome Measures: Clinical presentation, best-corrected visual acuity (BCVA), fundus abnormalities, visual field defects, ffERG changes, and presence of antiretinal antibodies. RESULTS Sixteen patients (64%) presented with photopsias, 56% (14/25) with night blindness, and 56% (14/25) with loss of peripheral vision. Sixty-four percent (16/25) of cases were bilateral. All patients demonstrated retinal vascular attenuation, optic nerve head pallor, and mottling of retinal pigment epithelium. The most common visual field changes included enlargement and expansion of the blind spot extending into large pericentral or other types of scotomata (64%). Both scotopic and photopic ffERG values were abnormal and affected to a similar degree in our patients. Nine patients (36%) had a greater than 20% asymmetry in ERG values between the 2 eyes. All patients had antiretinal antibodies on Western blot with an average of 6.6 bands. CONCLUSION Evidence suggests that AZOOR is a unique form of autoimmune retinopathy and retinal manifestation suggests possible antiretinal antibody leakage from the disc margin with spread of immune products under the retina, resulting in large scotomata that connect to the optic nerve head.
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25
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Gilhooley MJ, Fraser CL, Wong S, Hickman SJ, Plant GT. Idiopathic Acquired Temporal Wedge Visual Field Defects. Neuroophthalmology 2016; 40:157-164. [PMID: 27928401 DOI: 10.1080/01658107.2016.1195413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 05/25/2016] [Accepted: 05/25/2016] [Indexed: 10/21/2022] Open
Abstract
Our aim is to report 13 unusual cases of acquired, temporal sectoral scotomas. Such stationary "wedge" field defects have been reported previously in cases of presumed congenital nasal hypoplasia of the optic disc and as a complication of vitreoretinal surgery. To our knowledge, the literature provides no reports of similar defects occurring spontaneously. This is a descriptive clinical case series of 13 patients presenting with sub-acute monocular temporal visual field loss. All were clinically assessed and investigated with Goldmann perimetry, automated Humphrey visual fields, retinal optical coherence tomography, orbital ultrasound, and standard and multi-focal electroretinography. Cases were followed with serial perimetry for a mean of 3.9 years (range: 6 months to 10 years). Goldmann and Humphrey perimetry both demonstrated "wedge"-shaped defects extending temporally from an apex contiguous with, or lateral to, the blind spot. There was no evidence of optic disc drusen, glaucoma, disc hypoplasia, or focal retinitis. Sectoral optic disc swelling was not present in any patient at presentation. In all cases, the visual field defect remained stable. One patient developed a similar defect in the fellow eye after an interval of 5 years. Here we describe 13 cases of acquired, stationary temporal wedge scotomas, novel in the literature. Although the aetiology is uncertain, we propose damage to the nasal rim of the optic disc as a likely mechanism.
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Affiliation(s)
| | - Clare L Fraser
- Save Sight Institute, University of Sydney , Sydney, Australia
| | - Sui Wong
- Moorfields Eye Hospital , London, United Kingdom
| | | | - Gordon T Plant
- Moorfields Eye Hospital, London, United Kingdom; The National Hospital for Neurology and Neurosurgery, London, United Kingdom
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26
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Ahnood D, Madhusudhan S, Tsaloumas MD, Waheed NK, Keane PA, Denniston AK. Punctate inner choroidopathy: A review. Surv Ophthalmol 2016; 62:113-126. [PMID: 27751823 DOI: 10.1016/j.survophthal.2016.10.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/05/2016] [Accepted: 10/10/2016] [Indexed: 12/14/2022]
Abstract
Punctate inner choroidopathy (PIC), an idiopathic inflammatory multifocal chorioretinopathy that predominantly affects young myopic women, appears to be relatively rare, but there are limited data to support accurate estimates of prevalence, and it is likely that the condition is underdiagnosed. The etiological relationship between PIC and other conditions within the "white dot syndromes" group remains uncertain. We, like others, would suggest that PIC and multifocal choroiditis with panuveitis represent a single disease process that is modified by host factors (including host immunoregulation) to cause the range of clinical phenotypes seen. The impact of PIC on the patient is highly variable, with outcome ranging from complete spontaneous recovery to bilateral severe sight loss. Detection and monitoring have been greatly facilitated by modern scanning techniques, especially optical coherence tomography and autofluorescence imaging and may be enhanced by coregistration of sequential images to detect change over time. Depending on the course of disease and nature of complications, appropriate treatment may range from observation to systemic immunosuppression and antiangiogenic therapies. PIC is a challenging condition where treatment has to be tailored to the patient's individual circumstances, the extent of disease, and the risk of progression.
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Affiliation(s)
- Dana Ahnood
- Department of Ophthalmology, Royal Glamorgan Hospital, Cwm Taf University Health Board, Cardiff, United Kingdom
| | - Savitha Madhusudhan
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Marie D Tsaloumas
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Centre for Rare Diseases, Institute of Translational Medicine, Birmingham Health Partners, Birmingham, United Kingdom
| | - Nadia K Waheed
- New England Eye Center, Tufts Medical Center, Tufts University School of Medicine, Boston, USA
| | - Pearse A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Alastair K Denniston
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Centre for Rare Diseases, Institute of Translational Medicine, Birmingham Health Partners, Birmingham, United Kingdom; Academic Unit of Ophthalmology, Institute of Inflammation & Ageing, University of Birmingham, Birmingham, United Kingdom.
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27
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Nakamura N, Fujinami K, Mizuno Y, Noda T, Tsunoda K. Evaluation of cone function by a handheld non-mydriatic flicker electroretinogram device. Clin Ophthalmol 2016; 10:1175-85. [PMID: 27445454 PMCID: PMC4936817 DOI: 10.2147/opth.s104721] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Purpose Full-field electroretinograms (ERGs) are used to evaluate retinal function in patients with various types of hereditary and acquired retinal diseases. However, ERG recordings require relatively invasive procedures, including pupillary dilation and the use of contact lens electrodes. Thus, it would be helpful to have a simpler and noninvasive screening method. The purpose of this study was to determine whether a new, handheld, portable ERG device, RETeval™, can be used to screen patients for cone dysfunction. Patients and methods Thirty-five eyes of 35 patients who had reduced cone responses ascertained by a conventional ERG system using contact lens electrodes were studied. The causative diseases included achromatopsia, cone dystrophy, cone-rod dystrophy, retinitis pigmentosa, choroidal dystrophy, autoimmune retinopathy, and Stargardt disease. The flicker ERGs were recorded with the RETeval™ under undilated conditions with skin electrodes (stimulus strength, 3.0 cd·s/m2; frequency, 28.3 Hz), and the responses were compared to that of 50 healthy eyes. The amplitudes and implicit times of the fundamental component of the flicker ERGs were analyzed in three age groups: Group A, ≤20 years; Group B, 21–40 years; and Group C, ≥41 years. Results In all of the age groups, the amplitudes of the ERGs were significantly smaller and the implicit times significantly longer in patients with cone dysfunction than in the control eyes. All but one of the patients had flicker amplitudes lower than the mean −2.0 standard deviation of control eyes. Conclusion The RETeval™ has a potential of being used to screen for cone dysfunction. The entire examination takes <5 minutes and does not require pupil dilatation or a contact lens electrode. Although the flicker responses do not provide information on the scotopic functions, the RETeval™ device can be used to determine which patients require additional full-field ERG testing with dilated pupils under both scotopic and photopic conditions.
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Affiliation(s)
- Natsuko Nakamura
- Laboratory of Visual Physiology, Division of Vision Research, National Institute of Sensory Organs
| | - Kaoru Fujinami
- Laboratory of Visual Physiology, Division of Vision Research, National Institute of Sensory Organs
| | - Yoshinobu Mizuno
- Department of Ophthalmology, National Hospital Organization, National Tokyo Medical Center, Tokyo, Japan
| | - Toru Noda
- Department of Ophthalmology, National Hospital Organization, National Tokyo Medical Center, Tokyo, Japan
| | - Kazushige Tsunoda
- Laboratory of Visual Physiology, Division of Vision Research, National Institute of Sensory Organs
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Hoh Kam J, Morgan JE, Jeffery G. Aged complement factor H knockout mice kept in a clean barriered environment have reduced retinal pathology. Exp Eye Res 2016; 149:116-125. [PMID: 27397653 DOI: 10.1016/j.exer.2016.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 06/14/2016] [Accepted: 07/06/2016] [Indexed: 01/02/2023]
Abstract
Age-related macular degeneration (AMD) is the largest cause of visual loss in those over 60 years in the West and is a condition increasing in prevalence. Many diseases result from genetic/environmental interactions and 50% of AMD cases have an association with polymorphisms of the complement system including complement factor H. Here we explore interactions between genetic predisposition and environmental conditions in triggering retinal pathology in two groups of aged complement factor H knock out (Cfh(-/-)) mice. Mice were maintained over 9 months in either a conventional open environment or a barriered pathogen free environment. Open environment Cfh(-/-) mice had significant increases in subretinal macrophage numbers, inflammatory and stress responses and reduced photoreceptor numbers over mice kept in a pathogen free environment. Hence, environmental factors can drive retinal disease in these mice when linked to complement deficits impairing immune function. Both groups of mice had similar levels of retinal amyloid beta accumulation. Consequently there is no direct link between this and inflammation in Cfh(-/-) mice.
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Affiliation(s)
- Jaimie Hoh Kam
- Institute of Ophthalmology, University College London, UK
| | - James E Morgan
- School of Optometry and Visual Science, Cardiff University, UK
| | - Glen Jeffery
- Institute of Ophthalmology, University College London, UK.
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Nakahara H, Kaburaki T, Tanaka R, Takamoto M, Ohtomo K, Karakawa A, Komae K, Okinaga K, Matsuda J, Fujino Y. Frequency of Uveitis in the Central Tokyo Area (2010–2012). Ocul Immunol Inflamm 2016; 25:S8-S14. [DOI: 10.3109/09273948.2015.1133840] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Hisae Nakahara
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Toshikatsu Kaburaki
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Rie Tanaka
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Mitsuko Takamoto
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Kazuyoshi Ohtomo
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Ayako Karakawa
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Keiko Komae
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Kimiko Okinaga
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Junko Matsuda
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Yujiro Fujino
- Department of Ophthalmology, Japan Community Healthcare Organization Tokyo Shinjuku Medical Center, Shinjuku-ku, Tokyo, Japan
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Matsui Y, Matsubara H, Ueno S, Ito Y, Terasaki H, Kondo M. Changes in outer retinal microstructures during six month period in eyes with acute zonal occult outer retinopathy-complex. PLoS One 2014; 9:e110592. [PMID: 25356549 PMCID: PMC4214711 DOI: 10.1371/journal.pone.0110592] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 09/19/2014] [Indexed: 11/19/2022] Open
Abstract
Purpose To study the changes in the outer retinal microstructures during a six month period after the onset of acute zonal occult outer retinopathy (AZOOR)-complex by spectral-domain optical coherence tomography (SD-OCT). Methods Seventeen eyes of 17 patients with the AZOOR-complex were studied. The integrity of the external limiting membrane (ELM), ellipsoid zone (EZ; also called the inner/outer segment junction), and interdigitation zone (IDZ; also called the cone outer segment tips) were evaluated in the SD-OCT images obtained at the initial visit and at six months. The three highly reflective bands were divided into three types; continuous, discontinuous, and absent. The integrity of the outer nuclear layer (ONL) was also assessed. Results Among the three highly reflective bands, the IDZ was most altered at the initial visit and least recovered at six months. Fifteen of 17 eyes (88%) had a recovery of at least one of the three bands at six months in the retinal area where the ONL was intact, and these areas showed an improvement of visual field. Three eyes (18%) had retinal areas where the ONL was absent at the initial visit, and there was no recovery in both the retinal structures and visual fields in these areas. Conclusions Our results indicate that more than 85% eyes with AZOOR-complex show some recovery in the microstructures of the outer retina during a six month period if the ONL is intact. We conclude that SD-OCT is a useful method to monitor the changes of the outer retinal microstructure in eyes with the AZOOR-complex.
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Affiliation(s)
- Yoshitsugu Matsui
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hisashi Matsubara
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Shinji Ueno
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuki Ito
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroko Terasaki
- Department of Ophthalmology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mineo Kondo
- Department of Ophthalmology, Mie University Graduate School of Medicine, Tsu, Japan
- * E-mail:
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Tagami M, Matsumiya W, Imai H, Kusuhara S, Honda S, Azumi A. Autologous antibodies to outer retina in acute zonal occult outer retinopathy. Jpn J Ophthalmol 2014; 58:462-72. [DOI: 10.1007/s10384-014-0347-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 08/14/2014] [Indexed: 10/24/2022]
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Nakahara H, Kaburaki T, Takamoto M, Okinaga K, Matsuda J, Konno Y, Kawashima H, Numaga J, Fujino Y, Amano S. Statistical analyses of Endogenous Uveitis Patients (2007–2009) in central Tokyo area and Comparison with Previous Studies (1963–2006). Ocul Immunol Inflamm 2014; 23:291-296. [DOI: 10.3109/09273948.2014.920036] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Acute zonal occult outer retinopathy with atypical findings. Case Rep Med 2014; 2014:290696. [PMID: 25140180 PMCID: PMC4129142 DOI: 10.1155/2014/290696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 06/11/2014] [Accepted: 06/12/2014] [Indexed: 11/17/2022] Open
Abstract
Background. To report a case of acute zonal occult outer retinopathy (AZOOR) with atypical electrophysiology findings. Case Presentation. A 23-year-old-female presented with visual acuity deterioration in her right eye accompanied by photopsia bilaterally. Corrected distance visual acuity at presentation was 20/50 in the right eye and 20/20 in the left eye. Fundus examination was unremarkable. Visual field (VF) testing revealed a large scotoma. Pattern and full-field electroretinograms (PERG and ERG) revealed macular involvement associated with generalized retinal dysfunction. Electrooculogram (EOG) light rise and the Arden ratio were within normal limits bilaterally. The patient was diagnosed with AZOOR due to clinical findings, visual field defect, and ERG findings. Conclusion. This is a case of AZOOR with characteristic VF defects and clinical symptoms presenting with atypical EOG findings.
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Bittencourt MG, Kherani S, Ferraz DA, Ansari M, Nasir H, Sepah YJ, Hanout M, Do DV, Nguyen QD. Variation of choroidal thickness and vessel diameter in patients with posterior non-infectious uveitis. J Ophthalmic Inflamm Infect 2014; 4:14. [PMID: 26530342 PMCID: PMC4884007 DOI: 10.1186/s12348-014-0014-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 05/15/2014] [Indexed: 11/10/2022] Open
Abstract
Background Choroidal thickness (CTh) and choroidal vessel diameter (VD) in the Haler’s layer were evaluated as markers of inflammatory insult in non-infectious uveitis (NIU). Spectral-domain optical coherence tomography (Spectralis®, Heidelberg Engineering Inc.) scans were acquired from 23 normal subjects (39 eyes – group 1), 7 subjects with high myopia (14 eyes – group 2), and 19 patients with NIU (23 eyes – group 3). In groups 1 and 2, CTh and VD were measured at 3 different points of the same horizontal OCT scan passing through the fovea and a mean calculated. Mean CTh and VD were calculated in 2 other locations, 2 mm superior and inferior from the chosen foveal horizontal scan. In group 3, three measurements of CTh and VD were obtained within 1 mm of a horizontal scan passing through a retinal lesion; mean CTh and VD were then computed. A ratio (R) between the VD and the corresponding CTh was calculated. Results Group 1, 2 and 3 mean age was 29.6, 29.1 and 45.9 years, respectively. Sixteen normal subjects, three myopic subjects and six NIU patients were male.. Group 1 mean CTh did not differ from group 2 (261.6±45.6 vs. 260.2±50.6 µm µm; p>0.05); mean VD was marginally higher in Group 2 (159.8±32.2 vs. 163.2±33.2 µm; p>0.05). Group 3 demonstrated thinner CTh (193.6±54.6 µm) than Groups 1 and 2 (p = 0.02 and <0.001). Group 3 mean VD (123.6±37.4 µm) was also less than that in Groups 1 and 2; the difference was statistically significant only when compared to group 2, p = 0.01. R did not differ across groups (p-values >0.05), indicating that variations in CTh and VD followed the same trend. Conclusions The study reports potential quantitative OCT-derived parameters that may be explored in future trials of non-infectious uveitis. Thinning of choroid and decrease of vessel diameter are observed in patients with chronic NIU compared to controls. Electronic supplementary material The online version of this article (doi:10.1186/s12348-014-0014-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Millena G Bittencourt
- Retina Imaging Research and Reading Center, Wilmer Eye Institute, Johns Hopkins University, 1800 Orleans Street Woods 259-A, Baltimore, MD, 21287, USA.
| | - Saleema Kherani
- Retina Imaging Research and Reading Center, Wilmer Eye Institute, Johns Hopkins University, 1800 Orleans Street Woods 259-A, Baltimore, MD, 21287, USA.
| | - Daniel A Ferraz
- Hospital das Clínicas, Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255 Instituto Central, Cerqueira César, São Paulo, SP, CEP 05403-900, Brazil.
| | - Mehreen Ansari
- Retina Imaging Research and Reading Center, Wilmer Eye Institute, Johns Hopkins University, 1800 Orleans Street Woods 259-A, Baltimore, MD, 21287, USA.
| | - Humzah Nasir
- Retina Imaging Research and Reading Center, Wilmer Eye Institute, Johns Hopkins University, 1800 Orleans Street Woods 259-A, Baltimore, MD, 21287, USA.
| | - Yasir J Sepah
- Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 985540 Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68198-5540, USA.
| | - Mostafa Hanout
- Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 985540 Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68198-5540, USA.
| | - Diana V Do
- Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 985540 Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68198-5540, USA.
| | - Quan Dong Nguyen
- Ocular Imaging Research and Reading Center, Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, 985540 Nebraska Medical Center, 3902 Leavenworth Street, Omaha, NE, 68198-5540, USA.
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Cheng CY, Hwang JF, Chen SN. Choroidal changes by ocular coherence tomography in white dot syndrome. Taiwan J Ophthalmol 2014. [DOI: 10.1016/j.tjo.2013.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Braithwaite T, Holder GE, Lee RWJ, Plant GT, Tufail A. Diagnostic features of the autoimmune retinopathies. Autoimmun Rev 2014; 13:534-8. [PMID: 24424196 DOI: 10.1016/j.autrev.2014.01.039] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2013] [Indexed: 12/24/2022]
Abstract
The term autoimmune retinopathy encompasses a spectrum of rare autoimmune diseases that affect retinal function, often but not exclusively at the level of the photoreceptor. They typically present with painless visual loss, which may be accompanied by normal fundus examination. Some are progressive, often rapidly. They present a diagnostic challenge because there are no standardised clinical or laboratory based diagnostic criteria. Included within the spectrum are cancer-associated retinopathy, melanoma-associated retinopathy and presumed non-paraneoplastic autoimmune retinopathy. Differentiation from other retinopathies can be challenging, with overlap in symptoms, signs, and investigation findings, and an absence of pathognomonic features. However, technological developments in ophthalmic imaging and serological investigation over the past decade are adding novel dimensions to the investigation and classification of patients with these rare diseases. This review addresses the clinical, imaging, and serological features of the autoimmune retinopathies, and discusses the relative strengths and limitations of candidate diagnostic features.
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Affiliation(s)
| | - G E Holder
- Moorfields Eye Hospital NHS Foundation Trust, UK; UCL Institute of Ophthalmology, UK
| | - R W J Lee
- Moorfields Eye Hospital NHS Foundation Trust, UK; UCL Institute of Ophthalmology, UK; School of Clinical Sciences, Faculty of Medicine and Dentistry, University of Bristol, UK
| | - G T Plant
- Moorfields Eye Hospital NHS Foundation Trust, UK; The National Hospital for Neurology and Neurosurgery, London, UK; St Thomas' Hospital, London, UK
| | - A Tufail
- Moorfields Eye Hospital NHS Foundation Trust, UK
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Barile GR, Garg A, Hood DC, Marr B, Hussein S, Tsang SH. Unilateral retinopathy secondary to occult primary intraocular lymphoma. Doc Ophthalmol 2013; 127:261-9. [PMID: 24081663 PMCID: PMC4107452 DOI: 10.1007/s10633-013-9409-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 09/09/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of the study is to report the clinical case of a 53-year-old woman whose presenting manifestation of primary intraocular lymphoma (PIOL) was unilateral retinal degeneration. METHOD A case report was created with review of clinical, imaging, electrophysiologic, and pathological investigations. RESULTS A 53-year-old woman with a distant history of ocular herpes simplex developed progressive central visual loss and intermittent photopsia over 4 years in her right eye. Ophthalmic examination revealed reduced visual acuity OD, central scotoma, and minimal ocular findings. Autofluorescence and infrared imaging revealed mild reflectance changes in the temporal macula, and spectral-domain optical coherence tomography identified mild disruptions of inner segment/outer segment junctions in the subfoveal region of the right eye. A mild window defect was seen on fluorescein angiography. Electrophysiology with multifocal electroretinogram (ERG) revealed evidence of unilateral macular dysfunction. Full-field ERGs revealed progressive global retinal dysfunction over 6 months, with unilateral decreases in amplitude and implicit time shifts, as seen in cases of autoimmune retinopathies. The eye eventually exhibited mild vitreous cellular infiltration on ophthalmoscopic examination, and vitrectomy diagnosed B cell non-Hodgkin's lymphoma. Further evaluation revealed no evidence of central nervous system or systemic disease, consistent with occult PIOL. CONCLUSIONS This case illustrates an atypical presentation of PIOL characterized by unilateral retinal disease presenting with symptoms and signs of macular dysfunction. Clinical and ERG features evolved into an acute zonal occult outer retinopathy (AZOOR)-like phenotype. PIOL should be considered in atypical cases of AZOOR with vitreal reactions, and some cases of AZOOR may be related to B cell lymphocyte disorders.
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Affiliation(s)
- Gaetano R. Barile
- Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital, New York, NY, USA
| | - Aakriti Garg
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, 635 West 165th Street, Room 218, New York, NY 10032, USA
| | - Donald C. Hood
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, 635 West 165th Street, Room 218, New York, NY 10032, USA. Department of Psychology, Columbia University, New York, NY, USA
| | - Brian Marr
- Ophthalmic Oncology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | | | - Stephen H. Tsang
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, 635 West 165th Street, Room 218, New York, NY 10032, USA. Bernard and Shirlee Brown Glaucoma Laboratory, Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
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Rahimy E, Sarraf D. Paraneoplastic and non-paraneoplastic retinopathy and optic neuropathy: Evaluation and management. Surv Ophthalmol 2013; 58:430-58. [DOI: 10.1016/j.survophthal.2012.09.001] [Citation(s) in RCA: 138] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 08/27/2012] [Accepted: 12/04/2012] [Indexed: 12/29/2022]
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Saito M, Saito W, Hashimoto Y, Yoshizawa C, Shinmei Y, Noda K, Ishida S. Correlation between decreased choroidal blood flow velocity and the pathogenesis of acute zonal occult outer retinopathy. Clin Exp Ophthalmol 2013; 42:139-50. [DOI: 10.1111/ceo.12143] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 05/21/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Michiyuki Saito
- Department of Ophthalmology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Wataru Saito
- Department of Ophthalmology; Hokkaido University Graduate School of Medicine; Sapporo Japan
- Department of Ocular Circulation and Metabolism; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Yuki Hashimoto
- Department of Ophthalmology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Chikako Yoshizawa
- Department of Ophthalmology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Yasuhiro Shinmei
- Department of Ophthalmology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Kousuke Noda
- Department of Ophthalmology; Hokkaido University Graduate School of Medicine; Sapporo Japan
- Department of Ocular Circulation and Metabolism; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Susumu Ishida
- Department of Ophthalmology; Hokkaido University Graduate School of Medicine; Sapporo Japan
- Department of Ocular Circulation and Metabolism; Hokkaido University Graduate School of Medicine; Sapporo Japan
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Acute Zonal Occult Outer Retinopathy: Vision Loss in an Active Duty Soldier. Case Rep Med 2013; 2013:240607. [PMID: 23606850 PMCID: PMC3625598 DOI: 10.1155/2013/240607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 02/21/2013] [Accepted: 03/12/2013] [Indexed: 11/17/2022] Open
Abstract
Objective. To describe a case of acute zonal occult outer retinopathy (AZOOR) in an active duty patient.Methods. In this paper we studied fundus photographs, optical coherence tomograph, Humphrey visual field 30-2, fundus autofluorescence images, fluorescein angiograms, and electroretinography.Results. Exam findings on presentation: a 34-year-old American Indian female presented with bilateral photopsias, early RPE irregularity, and an early temporal visual field defect. Progression RPE damage and visual field defect along with ERG findings support final diagnosis of AZOOR.Conclusion. AZOOR may initially be identified as a broader category of disease called the “AZOOR complex of disorders”. Specific visual field defects, ERG results, and clinical exam findings will help distinguish AZOOR from other similar disorders.
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The characterization of retinal phenotype in a family with C1QTNF5-related late-onset retinal degeneration. Retina 2012; 32:1643-51. [PMID: 22277927 DOI: 10.1097/iae.0b013e318240a574] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the clinical, spectral-domain optical coherence tomography and electrophysiological features of C1QTNF5-associated late-onset retinal degeneration in a molecularly confirmed pedigree. METHODS Five members of a family participated, and affected individuals (n = 4) underwent detailed ophthalmologic evaluation including fundus autofluorescence and spectral-domain optical coherence tomography imaging and electroretinography. Electrooculography was performed in three individuals. RESULTS The visual acuity was initially normal and worsened with time. Anterior segment abnormalities included peripupillary iris atrophy and long anterior insertion of zonules. Peripapillary atrophy, drusenoid deposition, and scalloped sectorial chorioretinal atrophy were observed in all older individuals (n = 3). Fundus autofluorescence demonstrated hypofluorescent areas corresponding to regions of chorioretinal atrophy. The spectral-domain optical coherence tomography demonstrated multiple areas of retinal pigment epithelium-Bruch membrane separation with intervening homogeneous deposition that corresponded to the drusenoid lesions and areas of chorioretinal atrophy. Electrooculography was normal in one individual and showed abnormally low dark trough measures in older individuals (n = 2). Electroretinography was normal in early stages (n = 1), but showed marked abnormalities in the rod system (n = 3), which was predominantly inner retinal (n = 2) in late stages. CONCLUSION Late-onset retinal degeneration is a progressive degeneration, and anterior segment abnormalities present early. The widespread sub-retinal pigment epithelium deposition seen on spectral-domain optical coherence tomography in older individuals appears to be a characteristic in late stages. Electrooculography demonstrates abnormalities only in late stages of the disease.
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Neutzner RV, Jäger M, Friedburg C, Deeg CA, Lorenz B. [Blind spot enlargement syndrome in acute zonal occult outer retinopathy with detection of autoantibodies against the retinal antigens CRALBP and S-Ag]. Ophthalmologe 2012; 108:1045-9. [PMID: 21904838 DOI: 10.1007/s00347-011-2406-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Acute zonal occult outer retinopathy (AZOOR) is a rare disease and is part of the white dot syndrome occurring bilaterally and often asymmetrically in young healthy myopic women. Characteristic findings are distinct focal lesions of the outer segments (OS) of the photoreceptor (PR) layer and abnormalities in fundus autofluorescence (FAF) within the lesions. Currently there is a lack of defined disease criteria, such as specific laboratory findings. Also no effective therapy is known which makes it difficult to diagnose, differentiate and treat AZOOR. Supplementation of antioxidants may become part of therapeutic options in AZOOR. A 19-year-old myopic woman presented with unilaterally reduced visual acuity. Due to the clinical features and with the help of FAF, spectral domain optical coherence tomography (SD-OCT) and perimetry the diagnosis of blind spot enlargement syndrome in AZOOR was made. Identification of autoantibodies specific for two retinal antigens (CRALBP and S-Ag) supports the concept of an autoimmunological origin of the disease. Systemic steroids were given but stopped almost 6 weeks later as no improvement was seen. In follow-up controls over 12 months the clinical picture remained unchanged without any further therapy.
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Affiliation(s)
- R V Neutzner
- Klinik und Poliklinik für Augenheilkunde, Justus-Liebig-Universität Gießen, UKGM GmbH, Standort Gießen, Gießen, Deutschland.
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Mkrtchyan M, Lujan BJ, Merino D, Thirkill CE, Roorda A, Duncan JL. Outer retinal structure in patients with acute zonal occult outer retinopathy. Am J Ophthalmol 2012; 153:757-68, 768.e1. [PMID: 22105799 DOI: 10.1016/j.ajo.2011.09.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 09/01/2011] [Accepted: 09/01/2011] [Indexed: 11/16/2022]
Abstract
PURPOSE To correlate visual function with high-resolution images of retinal structure using adaptive optics scanning laser ophthalmoscopy (AOSLO) in 4 patients with acute zonal occult outer retinopathy (AZOOR). DESIGN Observational case series. METHODS Four women, aged 18 to 51, with acute focal loss of visual field or visual acuity, photopsia, and minimal funduscopic changes were studied with best-corrected visual acuity (BCVA), Goldmann kinetic and automated perimetry and fundus-guided microperimetry, full-field and multifocal electroretinography (ffERG and mfERG), spectral-domain optical coherence tomography (SD-OCT), and AOSLO imaging. Cone spacing was measured in 4 eyes and compared with 27 age-similar normal eyes. Additional functional testing in 1 patient suggested that cones were absent but rods remained. Serum from all patients was analyzed for anti-retinal antibody activity. RESULTS In all patients vision loss was initially progressive, then stable. Symptoms were unilateral in 2 and bilateral but asymmetric in 2 patients. In each patient, loss of retinal function correlated with structural changes in the outer retina. AOSLO showed focal cone loss in most patients, although in 1 patient with central vision loss such change was absent. In another patient, structural and functional analyses suggested that cones had degenerated but rods remained. Anti-retinal antibody activity against a ∼45 kd antigen was detected in 1 of the patients; the other 3 patients showed no evidence of abnormal anti-retinal antibodies. CONCLUSIONS Focal abnormalities of retinal structure correlated with vision loss in patients with AZOOR. High-resolution imaging can localize and demonstrate the extent of outer retinal abnormality in AZOOR patients.
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Affiliation(s)
- Marianna Mkrtchyan
- School of Optometry, University of California Berkeley, Berkeley, California, USA
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Lee V, Rekhi E, Hoh Kam J, Jeffery G. Vitamin D rejuvenates aging eyes by reducing inflammation, clearing amyloid beta and improving visual function. Neurobiol Aging 2012; 33:2382-9. [PMID: 22217419 DOI: 10.1016/j.neurobiolaging.2011.12.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 11/09/2011] [Accepted: 12/01/2011] [Indexed: 01/17/2023]
Abstract
Vitamin D(3) plays a key role in immune regulation and may protect against the aging process. A focal point for age-related changes is the outer retina of the eye where there is high metabolic demand resulting in a gradual increase in extracellular deposition, inflammation, and cell loss giving rise to visual decline. Here, we demonstrate that vitamin D(3) administration for only 6 weeks in aged mice significantly impacts on this aging process. Treated mice showed significant reductions in retinal inflammation and levels of amyloid beta (Aβ) accumulation, which is a hallmark of aging. They also had significant reductions in retinal macrophage numbers and marked shifts in their morphology. These changes were reflected in a significant improvement in visual function, revealing that vitamin D(3) is a route to avoiding the pace of age-related visual decline. Excess amyloid beta deposition and inflammation are risk factors leading to age-related macular degeneration (AMD), the largest cause of blindness in those older than 50 years in developed countries. Recently, vitamin D(3) has been linked epidemiologically to protection against age-related macular degeneration. Hence, vitamin D(3) enrichment is likely to represent a beneficial route for those at risk.
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Affiliation(s)
- Vivian Lee
- University College London, Institute of Ophthalmology, UK
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Butler NJ, Smith JR. Imaging in the diagnosis and management of acute zonal occult outer retinopathy. Int Ophthalmol Clin 2012; 52:257-261. [PMID: 22954948 DOI: 10.1097/iio.0b013e318265d3fd] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Chai Y, Yamazaki H, Fujinami K, Tsunoda K, Yamamoto S. Case of acute zonal occult outer retinopathy with abnormal pattern visual evoked potentials. Clin Ophthalmol 2011; 5:1235-41. [PMID: 21966193 PMCID: PMC3180490 DOI: 10.2147/opth.s23194] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Electrophysiological and morphological findings were studied in a case of acute zonal occult outer retinopathy (AZOOR) showing abnormal pattern visual evoked potentials (VEPs) at the onset and significant functional recovery in the natural course. A 21-year-old woman presented with acute onset of photopsia and a large scotoma in the right eye of 2 weeks duration. Her visual acuity was 20/20 in both eyes with no ophthalmoscopic and fluorescein angiographic abnormalities. However, a relative afferent pupillary defect and an enlarged blind spot were found in the right eye. The pattern VEPs were severely reduced when the right eye was stimulated. The amplitudes of both rod and cone full-field electroretinographics (ERGs) were reduced in the right eye. The amplitudes of the multifocal ERGs were reduced in the area of the enlarged blind spot. Irregularities in the inner segment/outer segment (IS/OS) line of the photoreceptors were observed over the nasal fovea by optical coherence tomography (OCT). The patient was followed without treatment. The enlarged blind spot disappeared in 3 months after the onset. At 5 months, reappearance of the IS/OS line was detected by OCT. At 6 months, the P100 recovered to normal values. At 1 year, the reduced full-field ERGs were almost normal size and the multifocal ERGs in the area corresponding to the enlarged blind spot were also improved. ERG findings are crucial for differentiating AZOOR from retrobulbar neuritis, especially in patients with abnormal pattern VEPs. The pattern VEPs, full-field ERGs, multifocal ERGs, and OCT images can be abnormal in the early phase of AZOOR, but they can all improve during the natural course.
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Affiliation(s)
- Yuzhu Chai
- Department of Ophthalmology, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
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Kure K, Obata R, Inoue Y, Iriyama A, Yanagi Y. Acute progression of electrophysiologically affected fellow eye in unilaterally symptomatic acute zonal occult outer retinopathy. Clin Ophthalmol 2011; 5:1167-70. [PMID: 21887099 PMCID: PMC3162297 DOI: 10.2147/opth.s23207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Indexed: 11/23/2022] Open
Abstract
Some patients with acute zonal occult outer retinopathy (AZOOR) show symptomatic acute visual impairment in one eye only, but electrophysiological abnormalities in both eyes. A 46-year-old female who had noticed paracentral scotoma of her right eye six months previously was referred to our hospital. At initial examination, her best-corrected visual acuity was 0.7 in the right eye and 1.2 in the left. Whereas the full-field rod electroretinogram (ERG) was normal in both eyes, the cone response was nonrecordable in the right eye and showed a significant decrease in amplitude in the left eye. The 30 Hz flicker ERG showed similar results. Multifocal ERG was nonrecordable in the right eye and showed a residual response in only the central part of the left. Fourteen months after the first visit, the patient presented complaining of acute visual acuity loss in the left eye. Visual acuity in her left eye had decreased to 0.01. The multifocal ERG was nonrecordable. Although the patient chose oral prednisolone therapy, only limited recovery was observed in the patient. Even if only the ERG shows changes and there are no other symptoms, ophthalmologists should continue observation in view of the possibility of an acute exacerbation.
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Affiliation(s)
- Kayo Kure
- Department of Ophthalmology, University of Tokyo School of Medicine, Tokyo, Japan
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Denton WJ, Jordan CW, McGill WJ. Bilateral, geographic, peripapillary, chorioretinal atrophy in a patient with porphyria cutanea tarda and high iron stores. ACTA ACUST UNITED AC 2011; 82:632-41. [PMID: 21775216 DOI: 10.1016/j.optm.2011.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 10/11/2010] [Accepted: 02/17/2011] [Indexed: 12/22/2022]
Abstract
PURPOSE Porphyria cutanea tarda (PCT) is a systemic disease caused by a deficiency of the enzyme uroporphyrinogen decarboxylase, which is the fifth enzyme in the heme biosynthetic pathway. This deficiency prevents porphyrin and its byproducts from producing heme. CASE REPORT This case report presents a patient with PCT that is further complicated by high iron stores, chronic hepatitis C virus (HCV), and a history of alcoholism. Bilateral, geographic, peripapillary chorioretinal atrophy is evident and shows progression over a significant period despite improving the PCT. CONCLUSION A bilateral and progressive appearance of a retinal pathology in a middle-age male patient, with no family ocular history, suggests systemic causation. One theory includes a back flow of porphyrin byproducts from PCT. This is exacerbated by a less-than-productive liver caused by high iron stores, chronic HCV, and a history of alcoholism, which prevents the normal filtering process to occur. We believe this is the first report of a case of presumed bilateral, geographic, peripapillary chorioretinal atrophy in a patient with PCT, complicated by high iron stores, HCV, and alcoholism.
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Affiliation(s)
- William J Denton
- Wm. Jennings Bryan Dorn Veterans Affairs Medical Center, Columbia, South Carolina, USA.
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