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Macular Dystrophy, Patterned

Clinical Characteristics

Ocular Features

Patterned dystrophies of the macula are clinically heterogeneous.  It is common for different patterns to be seen among multiple members of a single family.  They can also be different in the two eyes of the same individual.  RPE changes can often be seen in the second decade of life but visual disturbances may not be noted until a decade or two later.  The process is progressive and eventually macular function is severely depressed with vision in the range of 20/200.  The pigmentary retinopathy occurs at the level of the RPE with the typical appearance of pigment but sometimes an accumulation of white or yellowish deposits is present.  The pattern of changes may appear in a configuration resembling the wings of a butterfly, hence the name.  However, vitelliform-like lesions have also been reported.  Paracentral tritan color defects have been described.

Subfoveal choroidal neovascularization can occur.

While the ERG may show some diffuse photoreceptor dysfunction in the presence of normal vision, there is little to suggest a primary rod or cone abnormality. Dark adaptation is normal.  Visual fields can reveal a small central scotoma and fluorescein angiography often shows window defects in the posterior pole. 

Systemic Features

No systemic disease has been linked to patterned macular dystrophy. 

Genetics

Pattern macular dystrophies are usually inherited as autosomal dominant conditions.  Several mutations in separate genes have been linked to these disorders suggesting that this group is genetically as well as clinically heterogeneous.  Some families have mutations in the photoreceptor peripherin gene (PRPH2) at 6p21.1-cen (169150) while a locus at 5q21.2-q33.2 containing an unknown mutation has been linked to a pattern dystrophy in other families (608970). 

Treatment Options

No treatment is available for the macular disease but low vision aids should be considered for appropriate individuals. 

Surveillance is useful for the detection of choroidal neovascularization and prompt treatment with ranibizumab injections can be useful in the elimination of this complication.

References

Weigell-Weber M, Kryenbühl C, Büchi ER, Spiegel R. Genetic heterogeneity in autosomal dominant pattern dystrophy of the retina. Mol Vis. 1996 Jun 20;2:6.

PubMed ID: 
9238083

Kim RY, Dollfus H, Keen TJ, Fitzke FW, Arden GB, Bhattacharya SS, Bird AC. Autosomal dominant pattern dystrophy of the retina associated with a 4-base pair insertion at codon 140 in the peripherin/RDS gene. Arch Ophthalmol. 1995 Apr;113(4):451-5.

PubMed ID: 
7710395

Nichols BE, Sheffield VC, Vandenburgh K, Drack AV, Kimura AE, Stone EM. Butterfly-shaped pigment dystrophy of the fovea caused by a point mutation in codon 167 of the RDS gene. Nat Genet. 1993 Mar;3(3):202-7.

PubMed ID: 
8485574

Vaclavik V, Tran HV, Gaillard MC, Schorderet DF, Munier FL. Pattern dystrophy with high intrafamilial variability associated with Y141C mutation in the peripherin/RDS gene and successful treatment of subfoveal CNV related to multifocal pattern type with anti-VEGF (ranibizumab) intravitreal injections. Retina. 2012 Oct;32(9):1942-9.

PubMed ID: 
22466463