Abstract
A 32-year-old female presented with complaints of progressive blurred vision that has manifested since she was 18 years. She had a past medical history of harelip s/p repair in childhood. She had visited many hospitals since then. In 2008, she visited another medical center. According to her medical record, her best-corrected visual acuity was 6/30 in both eyes. Humphrey 30-2 was grossly normal (Fig. 54.1). Electroretinography (ERG) showed normal rod and cone responses in both eyes. Multifocal ERG revealed decreased central peaks in both eyes. The patient was suspected to have cone dystrophy, though no macular lesions could be found. She came to our clinic in 2013. Her best-corrected visual acuity remained 6/30 in both eyes. Anterior segments were normal with prompt pupillary light reflexes. Fundoscopic examination was normal for both eyes (Fig. 54.2). A full-field ERG showed normal rod and cone responses (Fig. 54.3), while a multifocal ERG showed decreased central peaks in both eyes (Fig. 54.4). Humphrey 10-2 demonstrated a small relative central scotoma in both eyes (Fig. 54.5). OCT showed a smear pattern of IS/OS segments in the central macula of both eyes (Fig. 54.6). The patient was suspected to have occult macular dystrophy. Peripheral blood DNA sequencing revealed a RP1L1 gene c.133 C > T mutation, which results in p.Arg45Trp of the RP1L1 protein. The diagnosis of occult macular dystrophy was confirmed, and the patient’s father was later found to carry the same mutation of the RP1L1 gene.
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References
Miyake Y, Ichikawa K, Shiose Y, Kawase Y. Hereditary macular dystrophy without visible fundus abnormality. Am J Ophthalmol. 1989;108:292–9.
Akahori M, Tsunoda K, Miyake Y, et al. Dominant mutations in RP1L1 are responsible for occult macular dystrophy. Am J Hum Genet. 2010;87:424–9.
Tsunoda K, Usui T, Hatase T, Yamai S, Fujinami K, Hanazono G, et al. Clinical characteristics of occult macular dystrophy in family with mutation of Rp1l1 gene. Retina-J Retinal Vitreous Dis. 2012;32:1135–47.
Ahn SJ, Cho SI, Ahn J, Park SS, Park KH, Woo SJ. Clinical and genetic characteristics of Korean occult macular dystrophy patients. Invest Ophthalmol Vis Sci. 2013;54(7):4856–63.
Miyake Y, Tsunoda K. Occult macular dystrophy. Jpn J Ophthalmol. 2015;59(2):71–80.
Conte I, Lestingi M, den Hollander A, Alfano G, Ziviello C, Pugliese M, Circolo D, Caccioppoli C, Ciccodicola A, Banfi S. Identification and characterisation of the retinitis pigmentosa 1-like1 gene (RP1L1): a novel candidate for retinal degenerations. Eur J Hum Genet. 2003;11(2):155–62.
Bowne SJ, Daiger SP, Malone KA, Heckenlively JR, Kennan A, Humphries P, Hughbanks-Wheaton D, Birch DG, Liu Q, Pierce EA, Zuo J, Huang Q, Donovan DD, Sullivan LS. Characterization of RP1L1, a highly polymorphic paralog of the retinitis pigmentosa 1 (RP1) gene. Mol Vis. 2003;9:129–37.
Pierce EA, Quinn T, Meehan T, McGee TL, Berson EL, Dryja TP. Mutations in a gene encoding a new oxygen-regulated photoreceptor protein cause dominant retinitis pigmentosa. Nat Genet. 1999;22:248–54.
Yamashita T, Liu J, Gao J, et al. Essential and synergistic roles of RP1 and RP1L1 in rod photoreceptor axoneme and retinitis pigmentosa. J Neurosci. 2009;29:9748–60.
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Wang, AG. (2018). Unexplained Visual Loss: Occult Macular Dystrophy. In: Emergency Neuro-ophthalmology . Springer, Singapore. https://doi.org/10.1007/978-981-10-7668-8_54
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