Abstract
PurposeTo evaluate the clinical features and investigate their relationship with visual function in Japanese patients with acute zonal occult outer retinopathy (AZOOR).MethodsFifty-two eyes of 38 Japanese AZOOR patients (31 female and 7 male patients; mean age at first visit, 35.0 years; median follow-up duration, 31 months) were retrospectively collected: 31 untreated eyes with good visual acuity and 21 systemic corticosteroid-treated eyes with progressive visual acuity loss. Variables affecting the logMAR values of best-corrected visual acuity (BCVA) and the mean deviation (MD) on Humphrey perimetry at initial and final visits were examined using multiple stepwise linear regression analysis.ResultsIn untreated eyes, the mean MD at the final visit was significantly higher than that at the initial visit (P = 0.00002). In corticosteroid-treated eyes, the logMAR BCVA and MD at the final visit were significantly better than the initial values (P = 0.007 and P = 0.02, respectively). The final logMAR BCVA was 0.0 or less in 85% of patients. Variables affecting initial visual function were moderate anterior vitreous cells, myopia severity, and a-wave amplitudes on electroretinography; factors affecting final visual function were the initial MD values, female sex, moderate anterior vitreous cells, and retinal atrophy.ConclusionsOur data indicated that visual functions in enrolled patients significantly improved spontaneously or after systemic corticosteroids therapy, suggesting that Japanese patients with AZOOR have good visual outcomes during the follow-up period of this study. Furthermore, initial visual field defects, gender, anterior vitreous cells, and retinal atrophy affected final visual functions in these patients.
Highlights
Acute zonal occult outer retinopathy (AZOOR), first described by Gass in 1993, is an idiopathic syndrome of acute outer retinal impairment [1]
In corticosteroid-treated eyes, the logarithm of minimal angle of resolution (logMAR) best-corrected visual acuity (BCVA) and mean deviation (MD) at the final visit were significantly better than the initial values (P = 0.007 and P = 0.02, respectively)
Our data indicated that visual functions in enrolled patients significantly improved spontaneously or after systemic corticosteroids therapy, suggesting that Japanese patients with
Summary
Acute zonal occult outer retinopathy (AZOOR), first described by Gass in 1993, is an idiopathic syndrome of acute outer retinal impairment [1]. Changes in the blood flow showed “inflammatory” pattern in the choroid, similar to our previous findings in patients with choroiditis, Vogt-Koyanagi-Harada disease [9], and serpiginous choroiditis [10]. From these observations, we hypothesized that inflammation in the choroid caused secondary photoreceptor impairment in AZOOR and may explain the absent or minimally abnormal retinal appearance during early stages of AZOOR, an alternative explanation is considered as follows; the outer retina is primarily affected by inflammation and destruction of photoreceptor outer segments leads to secondary reduction of the choroidal blood flow [11]
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