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Gyrate atrophy
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Gyrate atrophy

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Contributors: Sid Schechet MD, Deepak Sobti MD, D. Chimene Richa MD
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Synopsis

First described by Jacobsohn in 1888 as "atypical retinitis pigmentosa," gyrate atrophy (GA) of the choroid and retina is a rare, autosomal recessive disease causing progressive chorioretinal degeneration detectable in the first decade of life. There are more than 150 documented cases known, with the highest rate of cases in Finland.

It is caused by mutations in the ornithine aminotransferase (OAT) gene, located on chromosome 10, which results in a 10- to 15-fold increase in plasma concentration of ornithine. The chorioretinal degenerative changes are caused by the hyperornithinemia, but the exact pathogenesis is unknown.

Patients with GA have hyperpigmented fundi, with lobular loss of the retinal pigment epithelium (RPE) and choroid. In early stages, patients have numerous, well-demarcated areas of atrophy of the RPE and choroid in the peripheral retina. These gradually coalesce and advance posteriorly to form a classic scalloped border at the junction of the normal and abnormal RPE. The ongoing atrophy of the choroid and retina causes progressively worsening nyctalopia (night blindness), visual field loss, myopia, posterior subcapsular cataracts, and a decline in visual acuity later in the course of the disease. Complete loss of vision, associated with macular involvement, typically occurs by the fourth or fifth decade of life.

The treatment goal in GA is to maintain normal serum ornithine levels. This has proven difficult, due to the rarity of the disease and allelic heterogeneity of the disease.

For more information, see OMIM.

Codes

ICD10CM:
H31.23 – Gyrate atrophy, choroid

SNOMEDCT:
314467007  – Gyrate Atrophy

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Choroideremia – Generalized hyperpigmentation of the remaining RPE helps to distinguish GA from choroideremia. Also, choroideremia is X-linked recessive.
  • Retinitis pigmentosa (RP) – RP would have bony spicules in retina, retinal arteriolar narrowing, and optic nerve waxy pallor.
  • Sorsby macular dystrophy
  • Pathologic myopia – The scalloped borders surround the optic nerve as opposed to being peripheral as in GA.
  • End-stage Stargardt disease
  • Aicardi syndrome – X-linked dominant. Also, the retinal lacunae are larger and more solitary.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed: 01/23/2017
Last Updated: 03/29/2017
Copyright © 2019 VisualDx®. All rights reserved.
Gyrate atrophy
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Gyrate atrophy : Night blindness, Vision loss, Visual field loss
Copyright © 2019 VisualDx®. All rights reserved.