Unilateral retinitis pigmentosa: Case report and review of the literature

Main Article Content

Denise Goodwin
Amanda M Olsen
Karl Citek

Abstract

Significance: Due to the limited number of reported cases little is known about the characteristics of unilateral retinitis pigmentosa. Information from additional case reports can aid in learning more about the condition. We report a case of retinitis pigmentosa that has remained unilateral for 28 years and review the available literature.


Case Report: A 40-year-old Caucasian female presented for an opinion as to the cause of her vision loss. Fundus autofluorescence demonstrated hypoautofluorescence in the midperipheral retina and a hyperautofluorescent ring surrounding the area of preserved photoreceptors in the macula. Optical coherence tomography showed disruption of the ellipsoid zone and the external limiting membrane. Electroretinography (ERG) showed severely reduced rod and cone function monocularly.


Discussion: Retinitis pigmentosa is typically bilateral and symmetric. Unilateral retinitis pigmentosa is a rare condition that manifests with only one eye having changes typical of retinitis pigmentosa. The unaffected eye can have no signs of retinitis pigmentosa and must have a normal ERG after long-term follow up. It is critical to rule out inflammatory, traumatic, toxic, and cancer associated retinopathy that can present with retinal pigmentary changes. Unilateral retinitis pigmentosa generally remains unilateral, but long-term follow up with ERG is important. There is currently no treatment that can stop the process of retinitis pigmentosa, but gene therapy shows promise.

Article Details

Goodwin, D., Olsen, A. M., & Citek, K. (2019). Unilateral retinitis pigmentosa: Case report and review of the literature. International Journal of Clinical and Experimental Ophthalmology, 3(2), 013–19. https://doi.org/10.29328/journal.ijceo.1001021
Case Reports

Copyright (c) 2019 de Goodwin D, et al.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Auerbach E, Rowe H. The “good” eye in unilateral retinitis pigmentosa. Ophthalmologica. 1968; 155: 98-116. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/5636434

Hartong DT, Berson EL, Dryja TP. Retinitis pigmentosa. Lancet. 2006; 368: 1795-1809. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17113430

Potsidis E, Berson EL, Sandberg MA. Disease course of patients with unilateral pigmentary retinopathy. Invest Opthalmology Vis Sci. 2011; 52: 9244-9249. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21989720

Francois J, Verriest G. Retinitis pigmentosa unilateral. Ophthalmologica. 1952; 124: 65-88. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/12993447

Weller JM, Michelson G, Juenemann AG. Unilateral retinitis pigmentosa: 30 years follow-up. BMJ Case Rep. 2014; bcr2013202236-bcr2013202236. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24515232

Brill TF. Marcus Gunn pupil in a possible case of unilateral retinitis pigmentosa. Am J Optom Physiol Opt. 1979; 56: 252-258. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/517626

Marsiglia M, Duncker T, Peiretti E, Brodie SE, Tsang SH. Unilateral retinitis pigmentosa: a proposal of genetic pathogenic mechanisms. Eur J Ophthalmol. 2012; 22: 654-660. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22139616

Pearlman JT, Saxton J, Hoffman G. Unilateral retinitis pigmentosa sine pigmento. Br J Ophthalmol. 1976; 60: 354-360. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1042728/

Alina-Cristina S, Marian B, Mihail Z. Unilateral pigmentary retinopathy – a review of literature and case presentation. Rom J Ophthalmol. 2016; 60: 47-52. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27220234

Thakur A, Puri L. Unilateral retinitis pigmentosa. Clin Exp Optom. 2010; 93: 102-104. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20406260

Kolb H, Galloway NR. Three cases of unilateral pigmentary degeneration. Br J Ophthalmol. 1964; 48: 471-479. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/14218207

Farrell DF. Unilateral retinitis pigmentosa and cone-rod dystrophy. Clin Ophthalmol. 2009; 3: 263-270. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/19668577

Padraglia C. Klinische beobachtungen. Retinitis pigmentosa. Klin Mbl Augenheilk. 1865; 3: 114-117. PubMed: https://www.ncbi.nlm.nih.gov/ pubmed/3259404

Skalka HW. Asymmetric retinitis pigmentosa, luetic retinopathy and the question of unilateral retinitis pigmentosa. Acta Ophthalmol (Copenh). 1979; 57: 351-357. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/474081

Seeliger M, Kretschmann U, Apfelstedt-Sylla E, Rüther K, Zrenner E. Multifocal electroretinography in retinitis pigmentosa. Am J Ophthalmol. 1998; 125: 214-226. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9467449

Bunker CH, Berson EL, Bromley WC, Hayes RP, Roderick TH. Prevalence of retinitis pigmentosa in Maine. Am J Ophthalmol. 1984; 97: 357-365. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/6702974

Spadea L, Magni R, Rinaldi G, Dragani T, Bianco G. Unilateral retinitis pigmentosa: clinical and electrophysiological report of four cases. Ophthalmologica. 1998; 212: 350-354. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9693297

Mukhopadhyay R. Holder GE, Moore AT, Webster AR. Unilateral retinitis pigmentosa occurring in an individual with a germline mutation in the rp1 gene. Arch Ophthalmol. 2011; 129: 954-956. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21746989

Heckenlively JR, Yoser SL, Friedman LH, Oversier JJ. Clinical findings and common symptoms in retinitis pigmentosa. Am J Ophthalmol. 1988; 105: 504-511. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/3259404

Ogura S, Yasukawa T, Kato A, Usui H, Hirano Y, et al. Wide-field fundus autofluorescence imaging to evaluate retinal function in patients with retinitis pigmentosa. Am J Ophthalmol. 2014; 158: 1093-1098. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25062603

Mitamura Y, Mitamura-Aizawa S, Nagasawa T, Katome T, Eguchi H, et al. Diagnostic imaging in patients with retinitis pigmentosa. J Med Invest. 2012; 59: 1-11. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22449988

Greenstein VC, Duncker T, Holopigian K, Carr RE, Greenberg JP, et al. Structural and functional changes associated with normal and abnormal fundus autofluorescence in patients with retinitis pigmentosa. Retina. 2012; 32: 349-357. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21909055

Escher P, Tran HV, Vaclavik V, et al. Double concentric autofluorescence ring in NR2E3-p.G56R-linked autosomal dominant retinitis pigmentosa. Investig Opthalmology Vis Sci. 2012; 53: 4754-4764. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22661467

Duncker T, Tabacaru MR, Lee W, Tsang SH, Sparrow JR. Comparison of near-infrared and short-wavelength autofluorescence in retinitis pigmentosa. Investig Opthalmology Vis Sci. 2013; 54: 585-591. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/23287793

Lima LH, Burke T, Greenstein VC, Chai LC, Wener C, et al. Progressive constriction of the hyperautofluorescent ring in retinitis pigmentosa. Am J Ophthalmol. 2012; 153: 718-727. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3830946/

Iriyama A, Yanagi Y. Fundus autofluorescence and retinal structure as determined by spectral domain optical coherence tomography, and retinal runction in retinitis pigmentosa. Graefes Arch Clin Exp Ophthalmol. 2012; 250: 333-339. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21947266

Battaglia Parodi M, La Spina C, Triolo G, Riccieri F, Pierro L, et al. Correlation of SD-OCT findings and visual function in patients with retinitis pigmentosa. Graefes Arch Clin Exp Ophthalmol. 2016; 254: 1275-1279. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26472300

Hagiwara A, Mitamura Y, Kumagai K, et al. Photoreceptor impairment on optical coherence tomographic images in patients with retinitis pigmentosa. Br J Ophthalmol. 2013; 97: 237-238. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/23172877

Yoon CK, Yu HG. The structure-function relationship between macular morphology and visual function analyzed by optical coherence tomography in retinitis pigmentosa. J Ophthalmol. 2013; 2013: 1-7. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3866715/

Guadagni V, Novelli E, Piano I, Gargini C, Strettoi E. Pharmacological approaches to retinitis pigmentosa: a laboratory perspective. Prog Retin Eye Res. 2015; 48: 62-81. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26113212

Rayapudi S, Schwartz SG, Wang X, Chavis P. Vitamin A and fish oils for retinitis pigmentosa. Cochrane Database Syst Rev. 2013; 12: CD008428. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24357340

Yoshida N, Ikeda Y, Murakami Y, Nakatake S, Fujiwara K. Factors affecting visual acuity after cataract surgery in patients with retinitis pigmentosa. Ophthalmology. 2015; 122: 903-908. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25601536

Gauvin M, Chakor H, Koenekoop RK, Little JM, Lina JM, et al. Witnessing the first sign of retinitis pigmentosa onset in the allegedly normal eye of a case of unilateral rp: a 30-year follow-up. Doc Ophthalmol. 2016; 132: 213-229. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27041556