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LETTER TO EDITOR
Year : 2007  |  Volume : 55  |  Issue : 4  |  Page : 321-322

Optical coherence tomographic features of unilateral macular coloboma


Smt. Kanuri Santhamma Retina Vitreous Centre, L.V. Prasad Eye Institute, L.V. Prasad Marg, Banjara Hills, Hyderabad - 500034, AP, India

Correspondence Address:
Nazimul Hussain
Smt. Kanuri Santhamma Retina Vitreous Centre, L.V. Prasad Eye Institute, L.V. Prasad Marg, Banjara Hills, Hyderabad - 500034, AP
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.33061

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How to cite this article:
Hussain N, Mohan Ram L S. Optical coherence tomographic features of unilateral macular coloboma. Indian J Ophthalmol 2007;55:321-2

How to cite this URL:
Hussain N, Mohan Ram L S. Optical coherence tomographic features of unilateral macular coloboma. Indian J Ophthalmol [serial online] 2007 [cited 2020 Feb 28];55:321-2. Available from: http://www.ijo.in/text.asp?2007/55/4/321/33061

Dear Editor,

Macular coloboma is believed to result from either a developmental abnormality or intrauterine inflammation. [1] Bilateral macular coloboma has been described earlier. [1],[2],[3],[4],[5] It has been seen in association with ocular or systemic abnormailities. [1] Optical coherence tomography (OCT) can enhance visualization of abnormal retinal structure. Here, we report a case of unilateral macular coloboma with macular dystrophy and its OCT characteristics.

A 30-year-old healthy young gentleman presented with complaints of blurred vision in the left eye which was noticed three months back when he had visited an ophthalmologist with the complaint of itching. There was no significant history suggestive of systemic illness. On examination, his best-corrected visual acuity was 20/25, N6 in the right eye and 20/160, N18 in the left eye. Color vision test on Ishihara's color test was normal. Amsler grid test was normal in the right eye and showed a central scotoma in the left eye. Intraocular pressure on applanation tonometry was 16 and 18 mmHg in the right and left eye respectively. Anterior segment examination was unremarkable in both eyes. Fundus examination showed focal areas of altered retinal pigment epithelium (RPE) and subretinal yellowish lesion in the foveal area [Figure - 1] in the right eye. Left eye showed a punched out circumscribed lesion in the center of the macula with thin foveal roof suggestive probably of the internal limiting membrane [Figure - 2]. A surrounding area of altered RPE was seen around the macular lesion.

Pattern electroretinogram (ERG) showed normal finding in the right eye and subnormal amplitude with mildly delayed implicit time in the left eye. Multifocal ERG showed normal appearance in right eye and depressed waveforms within 15 in the left eye which was more marked within 10 . Full field ERG for photopic and scotopic responses was normal. The OCT of the right eye showed normal study [Figure - 1]. Left eye showed bowl-shaped punched out morphology with shelving edge [Figure - 2]. A thin highly reflective membrane was seen central to the sharp edge. This characteristic contour was within the fovea. The findings were highly suggestive of coloboma. Fundus fluorescein angiography showed multiple stippled hyperfluorescence with late staining and minimal leakage in the macula in the right eye [Figure - 1]. Left eye showed a well-circumscribed darkly hypofluorescent area with relative hypofluorescence in the late phase [Figure - 2]. A surrounding area of RPE window defect was seen. Based on the clinical and investigative findings, a diagnosis of macular coloboma in the left eye and possible macular dystrophy in the right eye was made.

Macular coloboma has been classified into three groups based on the ophthalmoscopic appearance. [4] Often, it is associated with previous intrauterine infection and/or systemic abnormalities, and usually they are bilateral. This unique pattern of bowl-shaped defect in the fovea with shelving edge and without scleral ectasia was the characteristic finding on OCT, which was never described before. The present case also describes a unilateral macular coloboma with macular dystrophy. The clinical picture of the right eye could mimic Best's dystrophy but OCT features were not characteristic. An electro-oculography could have ruled out Best's disease. However, macular coloboma or dysplasia can occur in patients with congenital retinal dystrophy. [4]

 
  References Top

1.
Chen MS, Yang CH, Huang JS. Bilateral macular coloboma and pigmented paravenous retinochoroidal atrophy. Br J Ophthalmol 1992; 76: 250-251   Back to cited text no. 1
[PUBMED]    
2.
Hayasaka V, Hayasaka S. Bilateral congenital macular coloboma in a boy with down syndrome. Eur J Ophthalmol 2004; 14: 565-567  Back to cited text no. 2
    
3.
Sharma S, Naqvi A, Cruess AF. Bilateral macular coloboma. Can J Ophthalmol 1996; 31(1): 27-28  Back to cited text no. 3
    
4.
Moore AT, Taylor DS, Harden A. Bilateral macular dysplasia ('colobomata') and congenital retinal dystrophy. Br J Ophthalmol 1985; 69: 691-699  Back to cited text no. 4
[PUBMED]    
5.
Yamaguchi K, Tamai M. Congenital macular coloboma in Down Syndrome. Ann Ophthalmol 1990; 22: 222-223  Back to cited text no. 5
[PUBMED]    


    Figures

  [Figure - 1], [Figure - 2]


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