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| PHOTO ESSAY |
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| Year : 2023 | Volume
: 3
| Issue : 2 | Page : 578-579 |
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Acute zonal occult outer retinopathy – An acquired bilaterally symmetrical fovea-sparing lesion
Nikulaa Parachuri, M Prabhushanker, G Geetha, Nipun Bagrecha
Department of Vitreo Retina, Sankara Eye Hospital, Coimbatore, Tamil Nadu, India
| Date of Submission | 06-Nov-2022 |
| Date of Acceptance | 16-Dec-2022 |
| Date of Web Publication | 28-Apr-2023 |
Correspondence Address:
Nikulaa Parachuri
16A, Sathy Road, Gnapathy, Shivanandha Puram, Coimbatore, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/IJO.IJO_2962_22
Keywords: AZOOR, autofluorescence, trizonal
How to cite this article:
Parachuri N, Prabhushanker M, Geetha G, Bagrecha N. Acute zonal occult outer retinopathy – An acquired bilaterally symmetrical fovea-sparing lesion. Indian J Ophthalmol Case Rep 2023;3:578-9 |
How to cite this URL:
Parachuri N, Prabhushanker M, Geetha G, Bagrecha N. Acute zonal occult outer retinopathy – An acquired bilaterally symmetrical fovea-sparing lesion. Indian J Ophthalmol Case Rep [serial online] 2023 [cited 2023 Jun 4];3:578-9. Available from: https://www.ijoreports.in/text.asp?2023/3/2/578/375006 |
A 45-year-old man presented with defective vision for 2 weeks. Best corrected visual acuity (BCVA) was 6/6 in the right eye. He was amblyopic in left eye with a BCVA of 6/12. The anterior segment examination was unremarkable. Fundus examination revealed mild pigment mottling changes in the posterior pole [Figure 1]. Autofluorescence revealed a symmetrical trizonal pattern consisting of normal zone of autofluorescence followed by a speckled zone of hyperautofluorescence and by a zone of hypoautofluorescence [Figure 2]. Visual fields demonstrated binasal scotoma [Figure 3]. Spectral domain optical coherence tomography revealed thinning of the outer nuclear layer and loss of ellipsoid zone in both eyes [Figure 4]. Based on the above findings, a diagnosis of acute zonal occult outer retinopathy (AZOOR) was made and oral steroids (1 mg/kg/day) were started. | Figure 1: Fundus picture of the right (a) and left eye (b) revealing mild pigment mottling changes in the posterior pole
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 | Figure 2: Autofluorescence of the right (b) and left eyes (a) revealing the classical trizonal pattern
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 | Figure 3: Visual fields of the right (a) and left eyes (b) demonstrating binasal scotoma
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 | Figure 4: SD OCT of the right (b) and left eyes (a) revealing paramacular loss of the Ellipzoid zone
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| Discussion | |  |
AZOOR was first originally described by Dr. Gass in 1992 in 13 young women characterized by sudden-onset scotoma, photopsia, and normal fundus at presentation, which later led to pigmentary changes. Although autoimmune/inflammatory and infectious etiologies have been put forth, the precise etiopathogenesis still remains to be decoded. Systemic steroids, antivirals, and biological agents have been tried with varying response. Spontaneous remission has also been documented.[1],[2]
The peculiar feature in our case was that it was against the classic description of AZOOR in young women with unilateral onset and peripapillary location. Our patient was a middle-aged male who had bilaterally symmetrical fovea-sparing C-shaped paramacular diffuse hyperautofluorescent lesion, which raises the question of why an acquired disease would cause a symmetrical lesion.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Gass JD, Agarwal A, Scott IU. Acute zonal occult outer retinopathy: A long-term follow-up study. Am J Ophthalmol 2002;134:329-39.  |
| 2. | Gass JD. Acute zonal occult outer retinopathy. Donders Lecture: The Netherlands Ophthalmological Society, Maastricht, Holland, June 19, 1992. J Clin Neuroophthalmol 1993;13:79-97. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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