Bilateral Multifocal Serous Retinal Pigment Epithelial Detachments Coexisting With Generalized Rod-Cone Dysfunction...

Bilateral multifocal serous retinal pigment epithelial detachment (PED) is uncommon, and its coexistence with generalized retinal dysfunction has rarely been reported. We report a 55-year-old man referred for bilateral fundus abnormalities who complained of a paracentral scotoma, photophobia, and nyctalopia. Best-corrected visual acuity was 20/16 in the right eye and 20/13 in the left eye. Fundus examination revealed numerous transparent, round serous PEDs distributed from the posterior pole to the equator in both eyes, with retinal pigment epithelium (RPE) atrophy adjacent to the vascular arcades. Optical coherence tomography showed multiple PEDs with hyporeflective lumens and outer retinal atrophy sparing the fovea. Fundus autofluorescence demonstrated hyperautofluorescent PED margins and hypoautofluorescent atrophic areas. Full-field electroretinogram (ERG) revealed severely reduced to non-recordable rod and combined rod-cone responses, with markedly reduced and delayed cone and 30-Hz flicker responses; Goldmann perimetry demonstrated bilateral ring scotomas. These findings indicated generalized rod-cone dysfunction resembling retinitis pigmentosa (RP). An extensive infectious and inflammatory workup was unremarkable, and no etiology was identified. The patient was managed conservatively and remained stable over two years of observation. This report documents a rare coexistence of bilateral multifocal serous PED and generalized rod-cone dysfunction resembling RP, characterized by multimodal imaging, full-field ERG, and Goldmann perimetry.