Indocyanine green angiography in a case of Bietti's disease

BIETTI’S CRYSTALLINE CORNEORETINAL DYSTROPHY: A CROSS-SECTIONAL STUDY

OBJECTIVE

To evaluate the prevalence of Bietti's corneoretinal dystrophy (BCD) in a reference population of retinitis pigmentosa (RP), and to document the disease course clinically and angiographically by a cross-sectional approach.

METHODS

Two hundred seven consecutive RP patients were ascertained within a 3-year period. All patients had a complete eye examination, including fluorescein and indocyanine green angiography (FA, ICG). Blood samples were collected for electron microscopy evaluation of circulating lymphocytes of BCD patients.

RESULTS

Six patients were diagnosed with BCD. Prevalence was 3% of nonsyndromic RP cases. Limbal corneal and intraretinal crystals were found in all cases. In the early phase of BCD, ICG revealed focal lobular areas of choriocapillary atrophy at the equator, with concomitant retinal pigment epithelium (RPE) changes at the posterior pole on FA. These lesions gradually progressed both anteriorly and posteriorly, sparing an incomplete peripapillary ring and macular island until late in the disease. Progressive sclerosis of ciliary and choroidal arteries was noted upon ICG. The presence of lysosomal crystals was documented in a subpopulation of circulating lymphocytes that seemed to increase with age.

CONCLUSION

The present study is the first to assess BCD prevalence in a population of retinitis pigmentosa patients, to describe clinically and angiographically its evolution from first symptom to legal blindness, and to localize the first fundus alterations not only at the posterior pole but also at the equator.

Clinical and functional findings in crystalline retinopathy

BACKGROUND

Crystalline retinopathy is an infrequently encountered disorder characterized by reflective retinal crystalline deposits. The clinical findings of seven patients with crystalline retinopathy are documented.

METHODS

Clinical features of crystalline retinopathy were studied retrospectively in seven patients, three of whom were followed up for 2 to 5 years.

RESULTS

Six patients had a similar fundus appearance, that is, the reflective yellow deposits located mainly in the deep retina with retinal pigment epithelium atrophy throughout the posterior pole and mid-peripheral retina and with choriocapillaris atrophy at the posterior pole. However, the results from electroretinogram responses were markedly variable. Two of the patients showed marked electroretinogram functional impairment. In addition, other sibling patients only 3 years apart in age had different degrees of disease expression.

CONCLUSION

There is considerable variability in functional manifestations among patients with crystalline retinopathy, even in intrafamilial cases.