PMC3180490_01
Fundus photograph, fluorescein angiographic image, Humphrey static perimetry, and Optical coherence tomography (OCT) of the right eye. (a) Fundus photograph at the onset showing that the retina was normal. (b) Fluorescein angiography at the onset showing normal vascular pattern and no leakage. (c) Humphrey static perimetry at the onset showing enlarged blind spot (30-2 strategy MD -21.97 dB). (d) Humphrey static perimetry 3 months after the onset showing marginally enlarged blind spot (30-2 strategy MD -1.90 dB). (e) OCT image at the onset showing irregular inner segment/outer segment (IS/OS) line over the nasal fovea. (f) OCT image 5 months after the onset showing reappearance of IS/OS line over the nasal fovea.. Abbreviation: MD, mean defect.
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The results of ophthalmoscopy (Figure 1A), fluorescein angiography (Figure 1B), blood screening, and brain magnetic resonance imaging (MRI) were within normal limits. Static perimetry with the Humphrey field analyzer showed an enlarged blind spot in the right eye (Figure 1C). Irregularities in the inner segment/outer segment (IS/OS) line of the photoreceptors over the nasal fovea were observed by Fourier-domain OCT (HD-OCT; Carl Zeiss Meditec, Oberkochen, Germany) (Figure 1E). The enlarged blind spot in static perimetry disappeared 3 months after our initial examination (Figure 1D). At 5 months, reappearance of the IS/OS line was detected by OCT over the nasal fovea (Figure 1F).
Pattern visual evoked potentials (VEPs). At the onset, pattern VEPs are severely reduced in the right eye. One month after the onset, the P100 component of the pattern VEPs has a prolonged latency of 130 milliseconds. Six months after the onset, the P100 recovers to 110 milliseconds.. Abbreviations: OD, right eye; OS, left eye.
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The pattern VEPs elicited by transient and steady-state stimuli to the right eye were severely reduced (Figure 2). At 6 months, the P100 recovered to 110 milliseconds (mean: 105.2 +- 6.4 milliseconds; normal range: 92.4-118.0 milliseconds) (Figure 2).
Full-field electroretinographics (ERGs). At the onset, the amplitudes of the rod and cone responses in the right eye are reduced to about 50% of those in the left eye. At the 1 year follow-up examination, the reduced full-field ERGs are improved to be approximately the same amplitudes as those from the left eye.. Abbreviations: DA, dark adapted; LA, light adapted; OD, right eye; OS, left eye.
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The amplitudes of the rod and cone responses in the right eye were reduced to about 50% of those in the left eye (Figure 3). The reduced full-field ERGs were improved to be approximately the same amplitudes as those from the left eye (Figure 3).
Multifocal electroretinographics (ERGs). At the onset, the multifocal ERGs are reduced in the right eye. At the 1 year follow-up examination, the multifocal ERGs have improved but are still reduced especially from the temporal retina. Shorter duration protocol with 61 hexagonal elements was used for the latest recording, because acceptable responses to 103 hexagonal elements could not be obtained due to fatigue of the patient during the recording.. Abbreviations: OD, right eye; OS, left eye.
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The multifocal ERGs recorded from the area of the enlarged blind spot were reduced (Figure 4). A mild improvement of the reduced multifocal ERGs was also observed (Figure 4).