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Unilateral electronegative ERG in a presumed central retinal artery occlusion.

Lima LH, Cella W, Brue C, Tsang SH - Clin Ophthalmol (2010)

Bottom Line: Goldmann perimetry revealed central scotoma in the right eye and no abnormalities in the left eye.Full-field ERG in the right eye described a reduction of the b-wave with a relative preservation of the a-wave which is characteristic of electronegative ERG.Hence, our case illustrates that ERG testing is essential for the work-up of individuals with suspected retinal vascular disorders.

View Article: PubMed Central - PubMed

Affiliation: Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.

ABSTRACT
A unilateral electronegative electroretinogram (ERG) was seen in a 94-year-old man with presumed central retinal artery occlusion. Goldmann perimetry revealed central scotoma in the right eye and no abnormalities in the left eye. Full-field ERG in the right eye described a reduction of the b-wave with a relative preservation of the a-wave which is characteristic of electronegative ERG. Hence, our case illustrates that ERG testing is essential for the work-up of individuals with suspected retinal vascular disorders.

No MeSH data available.


Related in: MedlinePlus

Color fundus photographs shows few drusen on the posterior pole in both eyes, and retinal pigment epithelium (RPE) atrophy with pigmentary clumps on the macular area of left eye. Minimal retinal artery narrowing can be observed in both eyes. Fundus fluorescein angiography depicts window defect in the posterior pole compatible with RPE atrophy in the left eye in the venous phase. There was no apparent delayed fluorescein filling in both eyes.
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f1-opth-4-1311: Color fundus photographs shows few drusen on the posterior pole in both eyes, and retinal pigment epithelium (RPE) atrophy with pigmentary clumps on the macular area of left eye. Minimal retinal artery narrowing can be observed in both eyes. Fundus fluorescein angiography depicts window defect in the posterior pole compatible with RPE atrophy in the left eye in the venous phase. There was no apparent delayed fluorescein filling in both eyes.

Mentions: Visual acuity at presentation was 20/80 in the right eye and 20/20 in the left eye. The patient’s central vision in the right eye progressively deteriorated but stabilized over six months, resulting in acuity of 20/100. Anterior segment examination was unremarkable, except for mild superficial punctate keratitis, a few guttata, more prominently on the left cornea, and pseudophakia. There was no iris neovascularization in both eyes. The funduscopic examination revealed hard drusen on the macular area in both eyes, and atrophic retinal pigment epithelium (RPE) changes with pigmentary clumps on the macular area of left eye. Minor retinal artery narrowing was observed in both eyes without optic atrophy (Figure 1A and 1B). Fundus fluorescein angiography (FA) was unremarkable in the right eye and revealed transmission defect in the posterior pole compatible with RPE abnormalities in the left eye (Figure 1C and 1D). FA choroidal phase was 6 seconds in the right eye and 5 seconds in the left eye; FA arteriovenous phase was 14 seconds in the right eye and 11 seconds in the left eye. Spectral domain optical coherence tomography (SD-OCT) demonstrated reduced thickness of the inner retina in both eyes but more prominently in the right eye (Figure 2). The thickness of the inner retina (from retinal nerve fiber layer to inner nuclear layer) was measured 600 μm, 1,000 μm, and 2,000 μm nasally and temporally from the fovea. We also measured the inner retina thickness at the same locations described previously in 10 normal age-matched control eyes. The measurements were performed using the 1,000 μm caliper available in the OCT-SLO Spectralis, Heidelberg Retina Angiograph 2 (Heidelberg Engineering, Dossenheim, Germany). Our measurements showed that the inner retina thicknesses were decreased at 600 μm, 1,000 μm, and 2,000 μm nasally and temporally from the fovea in the patient’s right eye in comparison to the left eye and normal control eyes (Figure 3). Goldmann perimetry demonstrated central scotoma in the right eye and no abnormalities in the left eye. Full-field ERG in the right eye was attenuated in both scotopic and photopic responses and revealed a b-wave smaller than the a-wave amplitude, ie, electronegative maximal response. In the left eye, minimal scotopic and photopic attenuation was observed (Figure 4). Western blot analysis of 1:500 dilutions of the patient’s serum did not show any reactivity against retinal protein extract.


Unilateral electronegative ERG in a presumed central retinal artery occlusion.

Lima LH, Cella W, Brue C, Tsang SH - Clin Ophthalmol (2010)

Color fundus photographs shows few drusen on the posterior pole in both eyes, and retinal pigment epithelium (RPE) atrophy with pigmentary clumps on the macular area of left eye. Minimal retinal artery narrowing can be observed in both eyes. Fundus fluorescein angiography depicts window defect in the posterior pole compatible with RPE atrophy in the left eye in the venous phase. There was no apparent delayed fluorescein filling in both eyes.
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC2993105&req=5

f1-opth-4-1311: Color fundus photographs shows few drusen on the posterior pole in both eyes, and retinal pigment epithelium (RPE) atrophy with pigmentary clumps on the macular area of left eye. Minimal retinal artery narrowing can be observed in both eyes. Fundus fluorescein angiography depicts window defect in the posterior pole compatible with RPE atrophy in the left eye in the venous phase. There was no apparent delayed fluorescein filling in both eyes.
Mentions: Visual acuity at presentation was 20/80 in the right eye and 20/20 in the left eye. The patient’s central vision in the right eye progressively deteriorated but stabilized over six months, resulting in acuity of 20/100. Anterior segment examination was unremarkable, except for mild superficial punctate keratitis, a few guttata, more prominently on the left cornea, and pseudophakia. There was no iris neovascularization in both eyes. The funduscopic examination revealed hard drusen on the macular area in both eyes, and atrophic retinal pigment epithelium (RPE) changes with pigmentary clumps on the macular area of left eye. Minor retinal artery narrowing was observed in both eyes without optic atrophy (Figure 1A and 1B). Fundus fluorescein angiography (FA) was unremarkable in the right eye and revealed transmission defect in the posterior pole compatible with RPE abnormalities in the left eye (Figure 1C and 1D). FA choroidal phase was 6 seconds in the right eye and 5 seconds in the left eye; FA arteriovenous phase was 14 seconds in the right eye and 11 seconds in the left eye. Spectral domain optical coherence tomography (SD-OCT) demonstrated reduced thickness of the inner retina in both eyes but more prominently in the right eye (Figure 2). The thickness of the inner retina (from retinal nerve fiber layer to inner nuclear layer) was measured 600 μm, 1,000 μm, and 2,000 μm nasally and temporally from the fovea. We also measured the inner retina thickness at the same locations described previously in 10 normal age-matched control eyes. The measurements were performed using the 1,000 μm caliper available in the OCT-SLO Spectralis, Heidelberg Retina Angiograph 2 (Heidelberg Engineering, Dossenheim, Germany). Our measurements showed that the inner retina thicknesses were decreased at 600 μm, 1,000 μm, and 2,000 μm nasally and temporally from the fovea in the patient’s right eye in comparison to the left eye and normal control eyes (Figure 3). Goldmann perimetry demonstrated central scotoma in the right eye and no abnormalities in the left eye. Full-field ERG in the right eye was attenuated in both scotopic and photopic responses and revealed a b-wave smaller than the a-wave amplitude, ie, electronegative maximal response. In the left eye, minimal scotopic and photopic attenuation was observed (Figure 4). Western blot analysis of 1:500 dilutions of the patient’s serum did not show any reactivity against retinal protein extract.

Bottom Line: Goldmann perimetry revealed central scotoma in the right eye and no abnormalities in the left eye.Full-field ERG in the right eye described a reduction of the b-wave with a relative preservation of the a-wave which is characteristic of electronegative ERG.Hence, our case illustrates that ERG testing is essential for the work-up of individuals with suspected retinal vascular disorders.

View Article: PubMed Central - PubMed

Affiliation: Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.

ABSTRACT
A unilateral electronegative electroretinogram (ERG) was seen in a 94-year-old man with presumed central retinal artery occlusion. Goldmann perimetry revealed central scotoma in the right eye and no abnormalities in the left eye. Full-field ERG in the right eye described a reduction of the b-wave with a relative preservation of the a-wave which is characteristic of electronegative ERG. Hence, our case illustrates that ERG testing is essential for the work-up of individuals with suspected retinal vascular disorders.

No MeSH data available.


Related in: MedlinePlus