Acquired bipolar cell disorder presenting with photophobia

Area of Science:

• Ophthalmology
• Retinal Diseases
• Electrophysiology

Background:

• Acute diffuse occult inner retinopathy (ADOIR) is a recently described condition.
• Patients typically present with unilateral photophobia, preserved visual acuity, and characteristic electroretinogram (ERG) findings (a-wave > b-wave).
• Night blindness and color vision deficits are usually absent in ADOIR.

Purpose of the Study:

• To report a case of ADOIR that progressed from unilateral to bilateral involvement.
• To highlight the diagnostic utility of ERGs in identifying ADOIR.

Main Methods:

• A 75-year-old woman with persistent photophobia post-cataract surgery was examined.
• Comprehensive ophthalmological evaluation including fundus photography, OCT, visual fields, and full-field and multifocal ERGs was performed.
• ERG analysis revealed a negative waveform with severely reduced rod, cone, and flicker responses, and reduced macular responses on multifocal ERG.

Main Results:

• The patient presented with unilateral photophobia, which later affected the fellow eye, leading to a diagnosis of bilateral ADOIR.
• ERG findings were key in diagnosing ADOIR, showing severely reduced responses in both eyes.
• OCT and fundus examinations were normal, underscoring the diagnostic importance of electrophysiology.

Conclusions:

• The patient was diagnosed with bilateral ADOIR based on clinical presentation and ERG findings.
• ERGs are essential for diagnosing ADOIR and understanding the retinal mechanisms underlying photophobia in this condition.