Upper hemiretinal occult retinopathy

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PurposeTo emphasize the significance of photopsias and positive scotomas as subjective indicators of occult retinopathy.MethodsThe patient’s depiction of his photopsias led to a diagnostic work-up by white and red static and kinetic perimetry, OCT, and visual electrophysiology.ResultsWithin the OD lower visual field our patient encountered a rapid loss of color vision. In dark environs, coloured photopsias showed up in this region, in bright environs, a positive black scotoma developped over time. Kinetic perimetry revealed a relative lower hemifield scotoma by white and an absolute one by red targets. On static perimetry, a distinct lower hemifield scotoma improved for white but persisted for red stimuli during 3 years of follow up. Retinal origin of the scotoma was proven by mf ERG. Serology for anti-retinal antibodies remained negative. Difficult to detect by ophthalmoscopy, an affection of the OS / RPE layer in the corresponding fundus area was proven by SD OCT.ConclusionColoured photopsias in dark, a black positive scotoma in bright envorons are salient symptoms of this upper hemifield occult retinopathy. OCT, visual fields and electrodiagnostic findings point towards a variant of AZOOR (acute zonal occult outer retinopathy).

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