Photoreceptor attenuation in acute zonal occult outer retinopathy

The purpose of this study is to report a case of acute zonal occult outer retinopathy and to describe a novel method of imaging photoreceptor damage using Cirrus spectral-domain optical coherence tomography (SD-OCT; Cirrus, Carl Zeiss Meditec, Dublin, CA) en face visualization. Our examination also included color fundus photographs, Goldmann visual field, fluorescein and indocyanine green angiography, fundus autofluo-rescence, and Ganzfeld electroretinography.

This is a case report of a single patient.

Despite 20/20 visual acuity in both of our patient's eyes, Goldmann visual field showed a unilateral C-shaped scotoma centered on the left optic nerve, sparing the fovea. Fundus and angiographic findings showed nonspecific pigmentary changes and hyperfluo-rescent foci along the superior and inferior vascular arcades. The electroretinography showed decreased scotopic amplitudes, with impaired 30-Hz flicker response, and Cirrus SD-OCT showed loss of the inner segment/outer segment photoreceptor junction. Cirrus SD-OCT Advanced Visualization three-dimensional reconstruction with en face visualization delineated an area of inner segment/outer segment attenuation corresponding to the Goldmann visual field scotoma. The patient's condition was unchanged at 5 months follow-up.

In addition to classic diagnostic modalities, photoreceptor attenuation observed with Cirrus SD-OCT can contribute to the diagnosis of acute zonal occult outer retinopathy and may help elucidate the etiology of this puzzling condition.