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Doc Ophthalmol (2010) 121:161166 DOI 10.1007/s10633-010-9236-z
CASE REPORT
Macular vitelliform lesion in desferrioxamine-related retinopathy
Mohamed A. Genead Gerald A. Fishman
Anastasios Anastasakis Martin Lindeman
Received: 5 March 2010 / Accepted: 24 May 2010 / Published online: 9 June 2010 Springer-Verlag 2010
Abstract To report a case of a macular vitelliform lesion associated with desferrioxamine treatment. Ocular, electrophysiological, psychophysical, peri-metric, uorescein angiographic, fundus autouorescence, and spectral-domain OCT examinations were obtained on a 45-year-old Caucasian woman with thalassemia major treated with blood transfusions and desferrioxamine. The patient was observed to have a vitelliform macular lesion in the right eye with a hypopigmented macular lesion and retinal pigment mottling in the left. At the most recent follow-up visit, best-corrected visual acuity was 20/70 in the right eye and 20/25 in left. Full-eld electroretino-gram (ERG) testing showed normal cone and rod responses. Mild localized elevations of rod psychophysical thresholds were found. A vitelliform macular lesion can develop in patients treated with desferrioxamine. Some such patients may not show diffuse photoreceptor cell functional loss as determined by electrophysiological testing.
Keywords Desferrioxamine toxicity
Macular vitelliform lesion
Electroretinogram measurement
Introduction
Desferrioxamine mesylate is an iron-chelating agent used in the treatment of chronic iron overload in patients with thalassemia major and other hemato-logic conditions requiring regular blood transfusions [1]. Ocular toxicity secondary to prolonged treatment with desferrioxamine may result in night blindness, a centrocaecal scotoma, constriction of the peripheral visual eld, pigmentary retinopathy, or optic neuropathy [28].
Macular and/or peripheral pigmentary degeneration are the most common changes described. The earliest fundus changes described are subtle opacication or loss in transparency of the outer retina and retinal pigment epithelium (RPE). These changes precede the development of RPE mottling. Peripapillary, papillomacular, and paramacular patterns of RPE degeneration have been previously demonstrated [9, 10].
Case report
A 45-year-old Caucasian woman of Italian ancestry had a history of progressive decrease in central vision of each eye (more in the right eye than the left). There was a 10-year history for the sudden onset of decreased visual acuity in each eye. The patients only other visual complaints were intermittent photoaversion and difculty seeing in dim light.
M. A. Genead G. A. Fishman (&) A. Anastasakis
M. LindemanDepartment of Ophthalmology and Visual Sciences (MC 648), University of Illinois at...