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Partial lipodystrophy with associated fundus abnormalities: an optical coherence tomography study
  1. G TRABUCCHI,
  2. C SANNACE,
  3. U INTROINI,
  4. R BRANCATO
  1. Department of Ophthalmology and Visual Sciences, Scientific Institute H S Raffaele, University of Milan, Italy
  1. Professor Rosario Brancato, Department of Ophthalmology and Visual Sciences, Scientific Institute H San Raffaele, University of Milano, Milano, Italy.

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Editor,—A patient with acquired partial lipodystrophy (PLD), associated with drusen-like lesions of the posterior pole, underwent fluorescein angiography (FA), electroretinogram (ERG), pattern electroretinogram (PERG), and electro-oculogram (EOG). In addition, optical coherence tomography (OCT) scans of the posterior pole were performed. Visual acuity was normal and the patient did not reveal metamorphopsia. There were, however, diffuse alterations at the EOG, whereas the ERG results were normal.

Drusen-like lesions have already been described in PLD and the associated EOG abnormalities were supposed to be related to Bruch’s membrane deposits.1-3 This study, by means of OCT, confirms that drusen-like lesions correspond with accumulation phenomena under retinal pigment epithelium (RPE) probably causing EOG abnormalities.

CASE REPORT

A 40 year old woman with a clinical history of acquired PLD was referred to our department on 4 March 1997 for routine examination. The general physical examination showed loss of subcutaneous fat from the face. Previous blood tests had found low serum level of C3 (3–4 mg/dl; normal value 70–140 mg/dl) in the presence of normal values of other clinical variables.

The visual acuity was normal in both eyes. The Amsler test was negative. Fundus examination showed yellow, drusen-like lesions in the posterior pole and in the mid-periphery of the retina. The optic nerves were normal.

The patient underwent FA and electrophysiological examinations (ERG, PERG, EOG).

Fluorescein angiography showed numerous hyperfluorescent diffuse spots in the posterior pole and in the mid-periphery of the retina, corresponding to the drusen-like lesions. These lesions were more numerous and larger temporally to the macula (Fig 1). The electrophysiological examinations revealed a reduction of the EOG light peak to dark through the Arden ratio. Flash and flicker ERG and PERG values were essentially normal. The OCT line scans of the macular region showed that the hyperreflective band relative to the RPE (red pseudocolour) was not regular. More specifically, the scan of the areas corresponding to drusen-like lesions showed how the red band was slightly lifted (Fig 2).

Figure 1

Fluorescein angiogram showing numerous hyperfluorescent drusen-like spots in the posterior pole. These lesions appear to be more numerous and larger temporally to the macula.

Figure 2

The OCT horizontal line scan of the macular region of the right eye (white line on Fig 1) shows that the hyperreflective band relative to the RPE (red pseudocolour) is not regular. The scan of the areas corresponding to drusen-like lesions shows how the red band is slightly lifted (white arrow).

COMMENT

O’Brien and colleagues described three cases of partial lipodystrophy associated with drusen-like lesions and alterations of EOG.1 They hypothesised that EOG abnormalities could be related to substance accumulation phenomena under RPE. Our case showed clinical features similar to those described by O’Brien et al.The potential of OCT examination for detecting macular diseases has already been pointed out.4 5 In this case, OCT examination found the presence of a non-regular pattern of RPE, associated with small solid liftings, corresponding to drusen-like lesions. This evidence confirms the presence of morphological alterations of the RPE, as was hypothesised, justifying the electrophysiological alterations.

References

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