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LETTER TO THE EDITOR
Year : 2018  |  Volume : 66  |  Issue : 1  |  Page : 176

Comment on: “Multimodal imaging in dominant cystoid macular dystrophy”


Department of Vitreoretina and Uvea, ICARE Eye Hospital and Postgraduate Institute, Noida, Uttar Pradesh, India

Date of Web Publication28-Dec-2017

Correspondence Address:
Dr. Koushik Tripathy
Department of Vitreoretina and Uvea, ICARE Eye Hospital and Postgraduate Institute, E3a, Sector-26, Noida - 201 301, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_862_17

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How to cite this article:
Tripathy K. Comment on: “Multimodal imaging in dominant cystoid macular dystrophy”. Indian J Ophthalmol 2018;66:176

How to cite this URL:
Tripathy K. Comment on: “Multimodal imaging in dominant cystoid macular dystrophy”. Indian J Ophthalmol [serial online] 2018 [cited 2019 Aug 21];66:176. Available from: http://www.ijo.in/text.asp?2018/66/1/176/221823



Sir,

The author read with interest the article on multimodal imaging of dominant cystoid macular dystrophy (DCMD).[1] There are few challenges that need discussion.

  1. Bilateral hyporeflective spaces in macular optical coherence tomography in a young male may also be noted in juvenile retinoschisis or X-linked retinoschisis (XLRS),[2] and peripheral retinoschisis may be absent in 50% of such cases. The fovea in magnified pictures of [Figure 1][1] does appear to have a spoke-wheel appearance which is typical of XLRS
  2. In the present case, both the foveae showed such hypoechoic spaces separated by vertically oriented retinal tissue bridges, which may be noted in foveoschisis of XLRS. A close differential diagnosis of such finding is cystoid macular edema (CME). However, CME shows typical petaloid leak (contrary to foveoschisis [3]) in the late phase of fundus fluorescein angiography. The first description of DCMD noted “typical CME due to leaking perimacular capillaries. Other striking features were retinal capillary leakage all over the posterior pole of the eye, whitish punctate deposits in the vitreous body, a normal electroretinogram, a subnormal electro-oculogram, and moderate-to-high hyperopia.”[4] The petaloid leak is not clearly demonstrated in [Figure 6] of the publication [1]
  3. In such a diagnostic dilemma, it would be interesting to know the fundus findings of the family members if they were examined. Reported patients of DCMD include Dutch family, American family with Greek ancestors, and patients from America and Spain.[5] All the 97 patients with DCMD in a large study had a single common Dutch ancestor. A pedigree chart with a search for an ancestor may be of help. The refractive error and axial length of the patient should be reported though both XLRS and DCMD can show hyperopia which may be more severe in DCMD. Electroretinogram shows a typical negative waveform with absent b wave in XLRS which unfortunately could not be performed as the patient refused such tests [1] as noted in the publication. Genetic analysis could also have helped in the exact diagnosis of the presented patient, which is difficult in Indian scenario due to the financial constraints


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Roy R, Saurabh K, Bhattacharyya S, Thomas NR, Datta K. Multimodal imaging in dominant cystoid macular dystrophy. Indian J Ophthalmol 2017;65:865-6.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Tripathy K, Chawla R, Meena S, Agarwal P. Unilateral giant peripapillary drusen and retinal drusenoid deposits in a case of X-linked retinoschisis. BMJ Case Rep 2016;2016.  Back to cited text no. 2
    
3.
Tripathy K, Chawla R, Sharma YR, Gogia V. Ultrawide field fluorescein angiogram in a family with gyrate atrophy and foveoschisis. Oman J Ophthalmol 2016;9:104-6.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Deutman AF, Pinckers AJ, Aan de Kerk AL. Dominantly inherited cystoid macular edema. Am J Ophthalmol 1976;82:540-8.  Back to cited text no. 4
[PUBMED]    
5.
Saksens NT, van Huet RA, van Lith-Verhoeven JJ, den Hollander AI, Hoyng CB, Boon CJ. Dominant cystoid macular dystrophy. Ophthalmology 2015;122:180-91.  Back to cited text no. 5
[PUBMED]    




 

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