Arginine-Restricted Therapy Resistant Bilateral Macular Edema Associated with Gyrate Atrophy

Abstract EN

Introduction.

Gyrate atrophy is a rare genetical metabolic disorder affecting vision.

Here, we report a 9-year-old boy with gyrate atrophy associated with bilateral macular edema at the time of diagnosis and the effect of long term metabolic control on macular edema.

Case Presentation.

A 9-year-old boy presented with a complaint of low visual acuity (best corrected visual acuity: 20/80 in both eyes, refractive error: −12.00 D).

Dilated fundus examination revealed multiple bilateral, sharply defined, and scalloped chorioretinal atrophy areas in the midperipheral and peripheral zone.

Spectral-domain optical coherence tomography revealed bilateral cystoid macular edema in both eyes.

Serum ornithine level was high (622 μmol/L).

An arginine-restricted diet reduced serum ornithine level (55 μmol/L).

However, visual findings including macular edema remained unchanged in 2 years of follow-up.

Conclusion.

Arginine-restricted diet did not improve macular edema in our patient with gyrate atrophy.

A more comprehensive understanding of the underlying factors for macular edema will lead to the development of effective therapies.