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Electrophysiological and microperimetry changes in vitamin A deficiency retinopathy

  • Clinical Case Report
  • Published:
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Abstract

Purpose

To describe a follow-up case of vitamin A deficiency (VAD)-related retinopathy with macular involvement monitored with electroretinography and microperimetry.

Methods

Flash (ERG), pattern (PERG), and multifocal (mfERG) electroretinography were recorded in parallel with microperimetry before and during 7-month follow-up of vitamin A treatment on a 65-year-old man presented with a 1-year history of night blindness. The patient had undergone ileostomy procedure for Crohn’s disease 14 years ago. His best corrected visual acuity was 6/6 in each eye. Fundus examination revealed macular and mid-peripheral yellow-white lesions compatible with drusen.

Results

Before treatment, PERG was reduced, and mfERG was reduced and delayed, worse in responses from the central rings. These results revealed evidence of bilateral macular and central cone dysfunction. The flash ERG showed reduced dark-adapted 0.01 ERG (rod response); a-wave of dark-adapted 3.0 and 10.0 ERG was normal but b-wave was reduced (negative configuration); light-adapted 3.0 ERG was slightly reduced. The flash ERG revealed evidence of bilateral generalised retinal dysfunction affecting the rod more than cone system. Microperimetry showed deep reduction in retinal sensitivity. Fixation stability was unstable with eccentric locus. During treatment, ERG and microperimetry demonstrated significant improvements. Fixation stability reached normal values after the third treatment week.

Conclusions

This case illustrates the importance of electrophysiological investigation in early VAD-related retinopathy detection correlated with microperimetry. Our findings indicate a more delayed central cone function recovery than that of generalised rod and cone function. There was a marked correlation between ERG and microperimetric changes.

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Conflict of interest

Marco Morales: Centervue Consultant. Financial interest. Remaining authors Saker Saker, Harsimar Jhittay, Yaqin Wen, Winfried Amoaku declared that they have no conflict of interest.

Patient consent

The patient has signed a consent form and has given permission to the research group of the Nottingham University to collect, store, analyse, and publish his case report in medical scientific journals. The patient has understood that his personal details will be kept confidential.

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Authors and Affiliations

  1. Ophthalmology and Visual Sciences, Division of Clinical Neuroscience, Queen’s Medical Centre, University of Nottingham, B Floor, Eye and ENT, Nottingham, NG72UH, UK

    Saker Saker, Marco Morales & Winfried Amoaku

  2. School of Medicine, Queen’s Medical Centre, University of Nottingham, Nottingham, NG72UH, UK

    Harsimar Jhittay

  3. Department of Medical Physics, Queen’s Medical Centre, Nottingham University Hospitals, Nottingham, NG72UH, UK

    Yaqin Wen

Authors
  1. Saker Saker
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  2. Marco Morales
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  3. Harsimar Jhittay
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  5. Winfried Amoaku
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Corresponding author

Correspondence to Winfried Amoaku.

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Saker, S., Morales, M., Jhittay, H. et al. Electrophysiological and microperimetry changes in vitamin A deficiency retinopathy. Doc Ophthalmol 130, 231–240 (2015). https://doi.org/10.1007/s10633-015-9484-z

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  • DOI: https://doi.org/10.1007/s10633-015-9484-z

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