Improvement of visual function in bilateral acute zonal occult outer retinopathy

• Published in: JAPANESE ORTHOPTIC JOURNAL Vol. 41; pp. 213 - 219
• Main Authors: Kinoshita, Mika, Okude, Sachiyo, Hayashi, Takaaki, Takeda, Hiroyuki, Tanaka, Fumi, Kitahara, Yumiko, Kitakawa, Takaaki, Gekka, Tamaki, Higashi, Yuka, Ohkuma, Yasuhiro, Kozaki, Kenichi, Kubo, Akiko, Tsuneoka, Hiroshi
• Format: Journal Article
• Language: Japanese; English
• Published: JAPANESE ASSOCIATION OF CERTIFIED ORTHOPTISTS 2012
• Subjects: antinuclear antibody; AZOOR; multifocal electroretinography; optical coherence tomography
• ISSN: 0387-5172; 1883-9215
• DOI: 10.4263/jorthoptic.041F123

Purpose: We reported a young female patient with bilateral acute zonal occult outer retinopathy (AZOOR) whose visual function was improved without any treatment. Subject: A 20-year-old woman presented with vision loss in her left eye. High myopia was detected two days later with the best-corrected visual acuity (BCVA) of 0.9 in the right eye and 0.2 in the left eye. A blood test was positive for antinuclear antibody but showed no systemic inflammation. Neither relative afferent pupillary defect nor abnormal brain MRI finding was detected. Visual field testing showed bilateral blind spot enlargement by Goldmann perimetry and sensitivity loss (MD values of -2.40 dB, P < 5% for the right and -8.74 dB, P < 0.5% for the left) with a Humphrey Field Analyzer (Central 30-2). No abnormal findings were detected in the ophthalmoscopic and angiographic tests. Spectral-domain optical coherence tomography (SD-OCT) revealed attenuation of the photoreceptor inner segment/outer segment junction (IS/OS) line in the left eye and attenuated cone outer segment tip (COST) line in the right eye. Reduced amplitudes in both eyes detected by multifocal electroretinograms (mfERG) resulted in a diagnosis of AZOOR. One month later, the left BCVA was improved to 1.0. About 9 months later, BCVA was 1.2 in both eyes and improved MD values were also observed (-1.79 dB, P < 10% for the right and -1.48 dB for the left) in the Humphrey testing. While no change in the SD-OCT finding was seen in the right eye, a marked improvement was observed in the left eye. Improved amplitudes were also found by mfERG in both eyes. Conclusion: Recovery of visual function is not always seen in AZOOR. Our present case showed improved visual function without recurrence in the natural course and indicated that visual function could be improved without any treatment in some patients with AZOOR.