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Stephen H. Tsang, MD, PhD; Veronika Vaclavik, MD; Alan C. Bird, MD; Anthony G. Robson, PhD; Graham E. Holder, PhD

Arch Ophthalmol. 2007;125(2):259-267.

Objective  To describe atypical phenotypes associated with the retinoschisis (X-linked, juvenile) 1 mutation (RS1).

Methods  Seven patients with multiple fine white dots at the macula and reduced visual acuity were evaluated. Six patients underwent pattern and full-field electroretinography (ERG). On-off ERG, optical coherence tomography, and fundus autofluorescence imaging were performed in some patients. Mutational screening of RS1 was prompted by the ERG findings.

Results  Fine white dots resembling drusenlike deposits and sometimes associated with retinal pigment epithelial abnormalities were present in the maculae. An electronegative bright-flash ERG configuration was present in all patients tested, and abnormal pattern ERG findings confirmed macular dysfunction. A parafoveal ring of high-density autofluorescence was present in 3 eyes; 1 patient showed high-density foci concordant with the white dots. Optical coherence tomography did not show foveal schisis in 3 of 4 eyes. All patients carried mutations in RS1, including 1 with a novel 206TC mutation in exon 4.

Conclusions  Multiple fine white dots at the macula may be the initial fundus feature in RS1 mutation. Electrophysiologic findings suggest dysfunction after phototransduction and enable focused mutational screening. Autofluorescence imaging results suggest early retinal pigment epithelium involvement; a parafoveal ring of high-density autofluorescence has not previously been described in this disorder.

Author Affiliations: Departments of Clinical Ophthalmology (Drs Tsang, Vaclavik, and Bird) and Electrophysiology (Drs Robson and Holder), Moorfields Eye Hospital, and Institute of Ophthalmology (Drs Vaclavik and Bird), London, England. Dr Tsang is now with Brown Glaucoma Laboratory, Department of Ophthalmology and Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University, New York, NY.

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