First Author: J.A.Caballero Agudo SPAIN
Co Author(s): I. Yago M. Hernandez J.M. Marin 0 0 0 0 0 0 0 0 0
Back to previous
To identify the relationship between retinal function and photoreceptor abnormalities in a patient with acute zonal occult outer retinopathy (AZOOR).
Department of Ophthalmology Virgen Arrixaca University Hospital, Murcia (Spain).
We report the case of a 40-year-old white man presented with an acute scotoma with photopsia inside in his left eye and diagnosed with AZOOR. We describe the findings of the ophthalmologic examination, including fundus photography, fluorescein angiography (FA), fundus autofluorescence (FAF), visual field (VF), microperimetry (MP), full-field electroretinogram (ERG) and spectral-domain optical coherence tomography (SD-OCT). SD-OCT findings were compared with retinal sensitivity measured by MP.
Best-corrected visual acuity was 1.0 in the right eye (RE) and 0.9 in the left eye (LE). Funduscopic examination was normal in the RE and showed an epimacular membrane and mild narrowed vascular retinal vessels in the LE. VF testing revealed a nasal mid-zonal scotoma in the RE and a peripheral contraction in the LE. FA showed mottled hyperfluorescence corresponding to changes in the RPE in both eyes (OU). On FAF there were hypoautofluorescent spots peripherally and a hyperautofluorescent ring at the posterior pole of OU. A SD-OCT examination demonstrated disruption in the inner segment/outer segment (IS/OS) junction line and in the OS tip line, as well as abnormal lamination of the inner retina with the presence of globular hyperreflective aggregates bilaterally. MP evidenced decreased retinal sensitivity in areas with photoreceptor abnormalities. Other findings: depressed scotopic and photopic amplitudes and a delayed 30-Hz cone flicker response on the full-field ERG; negative Anti-recoverin / Anti-A-enolase antibodies.
In this case, there is a coincidence between the visual disturbances perceived by the patient and the morphological alterations of the retina. The retinal areas with disruption of the IS/OS junction line and the OS tip line on SD-OCT showed reduced sensitivity on MP. In eyes with AZOOR, functional impairment is correlated with photoreceptor abnormalities. These alterations can be found mainly by MP and SD-OCT.