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   Table of Contents      
LETTER TO THE EDITOR
Year : 2018  |  Volume : 66  |  Issue : 1  |  Page : 176-177

Response to comment on “Multimodal imaging in dominant cystoid macular dystrophy”


Department of Vitreoretina, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India

Date of Web Publication28-Dec-2017

Correspondence Address:
Dr. Rupak Roy
Aditya Birla Sankara Nethralaya, 147, Mukundapur, E. M. Bypass, Kolkata - 700 099, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_897_17

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How to cite this article:
Roy R, Saurabh K, Bhattacharyya S, Thomas NR, Datta K. Response to comment on “Multimodal imaging in dominant cystoid macular dystrophy”. Indian J Ophthalmol 2018;66:176-7

How to cite this URL:
Roy R, Saurabh K, Bhattacharyya S, Thomas NR, Datta K. Response to comment on “Multimodal imaging in dominant cystoid macular dystrophy”. Indian J Ophthalmol [serial online] 2018 [cited 2019 Nov 14];66:176-7. Available from: http://www.ijo.in/text.asp?2018/66/1/176/221826



Sir,

We thank authors [1] for their interest in our article “Multimodal imaging in dominant cystoid macular dystrophy (DCMD).”[2]

Differential diagnosis of bilateral cystoid macular edema in a young adult with no systemic disorder or inflammation includes Goldman-Favre syndrome, retinitis pigmentosa, juvenile X-linked retinoschisis (XLRS), stellate nonhereditary idiopathic foveomacular retinoschisis, autosomal dominant cystoid macular edema, and various medication-induced maculopathies, such as niacin and paclitaxel.[3]

XLRS usually presents in the first or second decade of life with variable visual loss; on the contrary, patients with DCMD become symptomatic in the third decade like our patient who presented quite late at the age of 30 years.[4]

Both XLRS and DCMD can present with hyporeflective spaces in optical coherence tomography (OCT). However, their OCT features have subtle but definite differences. OCT in XLRS classically shows cavitations in neurosensory retina with thin vertical interconnecting septa and often become confluent, which is usually not the case with DCMD who have preponderance of cystoid spaces as in our case.[3]

Fundus fluorescein angiography (FFA) in XLRS shows no leakage. FFA in DCMD shows leakage of variable degree depending on the stage of the disease. Our case [Figure 6] of publication] shows leakage albeit faint which can be appreciated in higher magnification. Fundus autofluorescence imaging in our case shows multispot hyperautofluorescence in fovea which can also be seen in XLRS. However, in addition to this, we find a broader area of hyperautofluorescence [Figure 3] and [Figure 4] of publication] suggestive of diffuse retinal pigment epithelial dysfunction. This pattern of hyperautofluorescence is not seen in XLRS, which is predominantly an inner retinal disease to start with. These findings point more toward DCMD.[4],[5]

We agree completely with authors regarding the utility of genetic testing, evaluation of family members and electrophysiological tests and accept the lack of them as a drawback of our report.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Tripathy K. Comment on: “Multimodal imaging in dominant cystoid macular dystrophy”. Indian J Ophthalmol 2018;66:176.  Back to cited text no. 1
  [Full text]  
2.
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. 2
[PUBMED]  [Full text]  
3.
Ganesh A, Stroh E, Manayath GJ, Al-Zuhaibi S, Levin AV. Macular cysts in retinal dystrophy. Curr Opin Ophthalmol 2011;22:332-9.  Back to cited text no. 3
[PUBMED]    
4.
Molday RS, Kellner U, Weber BH. X-linked juvenile retinoschisis: Clinical diagnosis, genetic analysis, and molecular mechanisms. Prog Retin Eye Res 2012;31:195-212.  Back to cited text no. 4
[PUBMED]    
5.
Saksens NT, van Huet RA, van Lith-Verhoeven JJ, den Hollander AI, Hoyng CB, Boon CJ, et al. Dominant cystoid macular dystrophy. Ophthalmology 2015;122:180-91.  Back to cited text no. 5
    




 

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