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Case Reports
. 2017 Dec 6;17(1):236.
doi: 10.1186/s12886-017-0638-5.

Acute Zonal Occult Outer Retinopathy (AZOOR): a case report of vision improvement after intravitreal injection of Ozurdex

Yi Chun Kuo  1 , Nancy Chen  1 , Rong Kung Tsai  2   3
Affiliations
Case Reports

Acute Zonal Occult Outer Retinopathy (AZOOR): a case report of vision improvement after intravitreal injection of Ozurdex

Yi Chun Kuo et al. BMC Ophthalmol. .

Abstract

Background: AZOOR was first described by Gass in 1993 as a syndrome with rapid loss of one or more extensive zones of the outer retinal segments. It is characterized by photopsia, minimal funduscopic changes, and electroretinographic abnormalities. The efficacy of systemic steroids in treating AZOOR has been previously described and advocated by the concept of autoimmune retinopathy. However, the use of intravitreal of sustained-released steroid had not been mentioned to date.

Case presentation: A 34-year-old man had sudden onset of central scotoma and photopsia in the left eye. His visual acuity continued deteriorating. The visual field defect demonstrated bilateral enlarged blind spots and altitudinal defects. Fluorescein angiography (FA) showed nonspecific retinal inflammation, and an electroretinogram (ERG) illustrated decreased amplitude of the b wave in both eyes. Optical coherence tomography (OCT) examinations revealed parafoveal loss of the photoreceptor inner/outer segment (IS/OS) junction. Therefore, acute zonal occult outer retinopathy (AZOOR) was diagnosed. Although his vision did not improve under the initial treatment of systemic corticosteroid and calcium channel blocker, remarkable improvement was noticed after the intravitreal injection(IVI) of Ozurdex, consistent with the recovered IS/OS junction disruption.

Conclusions: We herein report a typical case of AZOOR, suggesting that the intravitreal injection of steroid may benefit in certain patients.

Keywords: Acute zonal occult outer retinopathy; Electroretinogram; Optical coherence tomography; Sustained-released steroid.

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Our patient consent to publish the image of eyes and other results of his medical examination in this manuscript or paper which may be published in your journal. Written consent was obtained from our patient.

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The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
VF defect (detected by Humphrey Visual Field Analyser 30–2) significantly subsided after one month of IVI of Ozurdex. (a, b) VF on the next day after onset of symptoms. (OD: Fixation losses: 1/21, false positive errors: 5% and false negative errors: 6%. OS: Fixation losses: 0/21, false positive errors: 0% and false negative errors: 5%) (c, d) One month after IVI, VF defect significantly subsided of both eyes. (OD: Fixation losses: 0/19, false positive errors: 4% and false negative errors: 7%. OS: Fixation losses: 1/21, false positive errors: 0% and false negative errors: 1%)
Fig. 2
Fig. 2
Binocular images of color fundoscopy, fundus autofluorescence, and fluorescein angiography on the next day after onset of symptoms. Color fundoscopy (a-b) revealed no specific finding except myopic crescent. Compared to the right eye (c), fundus autofluorescence revealed hyper-autofluorescence of the left eye (d). Fluorescein angiography (e-f) revealed retina small vessels vasculitis inflammation of the left eye(f)
Fig. 3
Fig. 3
OCT revealed change of IS/OS junction before and after treatment. a On the next day after onset of symptom, OCT revealed parafoveal loss (between arrows) of the photoreceptor IS/OS junction. b OCT revealed restoration (between arrows) of IS/OS junction after two weeks of IVI of Ozurdex
Fig. 4
Fig. 4
(a, b) ERG illustrated decreased amplitude of b wave of scotopic stimulations in both eyes
See this image and copyright information in PMC

References

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