Potential implications for pathophysiology in a type 1 diabetic patient affected by Stargardt disease

To present a 35-year-old woman affected by type 1 diabetes mellitus, Stargardt maculopathy and fundus flavimaculatus. To our knowledge, this association is unusual and not yet described in the ophthalmic literature.

Visual acuity was reduced to < 20/200 in both eyes, color vision was absent and computerized perimetry showed an absolute central scotoma. Pattern visual evoked potentials and electroretinogram (ERG) (scotopic, photopic and flicker) were considerably reduced in amplitudes. Full-field ERG was within normal limits whereas oscillatory potentials were reduced in number and amplitude. Fluorescein angiography confirmed the diagnosis of Stargardt maculopathy and fundus flavimaculatus but no diabetic retinopathy was clinically evident. Potential interactions between the diabetic microangiopathy and the retinal degenerative disorder are hypothesized and discussed.