Acquired bipolar cell disorder presenting with photophobia

Patients have been recently reported who had a common symptom of unilateral photophobia. The electroretinograms (ERGs) recorded from the eyes of these patients had a negative shape with the a-wave normal to slightly attenuated, and the rod and cone responses severely reduced, i.e., a-wave > b-wave. The patients did not complain of night blindness, and the visual acuity and color vision were relatively well preserved. These patients were diagnosed with acute diffuse occult inner retinopathy (ADOIR). We report our findings in such a case in which the unilateral findings progressed to the fellow eye. In the end, we diagnosed our case with bilateral ADOIR.

The patient was a 75-year-old woman whose main complaint was photophobia. She had undergone cataract surgery on both eyes by a neighborhood ophthalmologist. However, her symptoms did not improve, and she was referred to the Saitama Medical University Hospital in May 202X. At our initial examination, she did not complain of night blindness, and her decimal visual acuity in the right eye was 1.0 and that of her left eye was 0.9. The fundus photographs and optical coherence tomographic (OCT) images and Goldmann perimetric visual fields were within normal limits. The full-field mixed electroretinograms (ERGs) had a negative shape with severely reduced rod, cone, and flicker responses in the right eye. Multifocal ERGs showed reduced responses only in the macula of both eyes.

We conclude that our patient had bilateral ADOIR. The ERGs were the key for reaching this diagnosis and would be important for determining the mechanism of photophobia that occurs at the retinal level.