Indian Journal of Ophthalmology

PHOTO ESSAY
Year
: 2019  |  Volume : 67  |  Issue : 2  |  Page : 271--273

Pigmented paravenous retinochoroidal atrophy


Saurabh Deshmukh1, Dipankar Das2, Hemalata Deka3, Harsha Bhattacharjee4, Awaneesh Upadhyay4, Krati Gupta1,  
1 Department of Ophthalmology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
2 Department of Ocular Pathology, Uveitis and Neuro-Ophthalmology, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
3 Department of Medical Retina, Sri Sankaradeva Nethralaya, Guwahati, Assam, India
4 Department of Vitreo-Retina Surgery, Sri Sankaradeva Nethralaya, Guwahati, Assam, India

Correspondence Address:
Dr. Saurabh Deshmukh
Sri Sankaradeva Nethralaya, 96, Basistha Road, Beltola, Guwahati - 781 028, Assam
India

Abstract




How to cite this article:
Deshmukh S, Das D, Deka H, Bhattacharjee H, Upadhyay A, Gupta K. Pigmented paravenous retinochoroidal atrophy.Indian J Ophthalmol 2019;67:271-273


How to cite this URL:
Deshmukh S, Das D, Deka H, Bhattacharjee H, Upadhyay A, Gupta K. Pigmented paravenous retinochoroidal atrophy. Indian J Ophthalmol [serial online] 2019 [cited 2019 Aug 26 ];67:271-273
Available from: http://www.ijo.in/text.asp?2019/67/2/271/250657


Full Text



Pigmented paravenous retinochoroidal atrophy (PPRCA) is a rare variant of retinochoroidal atrophy (RCA) characterized by bilateral pigment accumulation along the retinal veins and RCA.[1] The disease etiology remains unknown. Majority of the cases are sporadic but some are hereditary in nature.[2]

 Case



A 24-year-old female presented with complaint of diminution of vision in both eyes (OU) for 1 year, with no past history of inflammation, trauma, or nyctalopia and no family history of retinal disorders. Best-corrected visual acuity was 6/6p OU. Biomicroscopic examination of anterior segment was unremarkable OU. Fundus examination showed pigment clumps along the retinal vascular arcade with chorioretinal atrophy extending from the disc up to the equator with no involvement of the macula OU [Figure 1]a and [Figure 1]b.{Figure 1}

Complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein, and random blood sugar levels were within normal limits. Antinuclear antibody (ANA) test was negative and venereal disease research laboratory (VDRL) test was nonreactive. OU fundus autofluorescence showed crescentic area of hyperfluorescence adjacent to area of chorioretinal atrophy [Figure 1]c and [Figure 1]d. Full-field analysis showed peripheral field constriction OU [Figure 2]a and [Figure 2]b. OCT revealed retinal thinning OU [Figure 2]c and [Figure 2]d. ERG showed reduced photopic and scotopic responses OU [Figure 2]e.{Figure 2}

 Discussion



Brown first reported a case of PPRCA in 1937 and termed it as retinochoroiditis radiata.[3] In PPRCA, the retinal pigment epithelium (RPE) damage leads to atrophy of the underlying choroid.[4] It is usually bilaterally symmetric but unilateral cases have also been reported.[5] The etiology remains unknown but mutations of CRB1 (crumbs homolog-1) gene have been implicated in its pathogenesis.[6] Patients usually are asymptomatic. In most cases, visual field may be normal, but some may have scotomas.[1] Fundus shows typical and characteristic pigment accumulation with RCA. Unaffected retina appears normal. Macula may be involved in some cases.[1] The differential diagnoses include chorioretinal degeneration and inflammatory diseases that cause chorioretinal atrophy. Yanagi et al. showed that the disease remains stationary in younger patients and slowly progress in older subjects.[7] Currently, no specific treatment modality is available for PPRCA. This photo essay highlights the salient diagnostic features in macular-sparing bilateral PPRCA in a young female.

Acknowledgments

We would like to thank Sri Kanchi Sankara Health and Educational Foundation, Guwahati, India.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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2Noble KG. Hereditary pigmented paravenous chorioretinal atrophy. Am J Ophthalmol 1989;108:365-9.
3Brown TH. Retino-choroiditis radiata. Br J Ophthalmol 1937;21:645-8.
4Young WO, Small KW. Pigmented paravenous retinochoroidal atrophy (PPRCA) with optic disc drusen. Ophthalmic Paediatr Genet 1993;14:23-7.
5Charbel Issa P, Scholl HP, Helb HM, Fleckenstein M, Inhetvin-Hutter C, Holz FG. Unilateral pigmented paravenous retinochoroidal atrophy. Klin Monbl Augenheilkd 2007;224:791-3.
6McKay GJ, Clarke S, Davis JA, Simpson DA, Silvestri G. Pigmented paravenous chorioretinal atrophy is associated with a mutation within the crumbs homolog 1 (CRB1) gene. Invest Ophthalmol Vis Sci 2005;46:322-8.
7Yanagi Y, Okajima O, Mori M. Indocyanine green angiography in pigmented paravenous retinochoroidal atrophy. Acta Ophthalmol Scand 2003;81:60-7.