Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 50, Num. 1, 2002, pp. 107-108

Neurology India, Vol. 50, No. 1, March, 2002, pp. 107-108

Leber's Idiopathic Stellate Neuroretinitis : Letter to Editor

V.S. Gurunadh, V. Baijal, M.G. Palit, A.K. Mahapatra

Department of Ophthalmology, Army Hospital, Delhi Cantt. , India.

Code Number: ni02031

Leber's idiopathic stellate neuroretinitis is a disorder with unilateral vision loss associated with optic disc edema and macular star formation. It is different from other forms of stellate, retinopathy by being a benign, self limiting condition.¹

A 51 year old female patient presented with complaints of diminution of vision in the right eye of 4 weeks duration, unassociated with any other ocular or systemic symptoms. She was a known hypertensive on treatment for the past 10 years. Examination revealed visual acuity of 6/36 in the right eye and 6/6 in the left eye. The funduscopy of the right eye revealed a clear media. The optic disc was hyperemic with blurred disc margins and peripapillary exudates. The macula was studded with a macular star of exudates. Rest of the fundus was within normal limits (Fig. 1). Left eye and fundus induding the periphery, was within normal limits. The ophthalmic picture was that of optic disc edema with a macular star. Neurological examination by a neurologist did not reveal any other deficit. CT scan was within normal limits. Visually evoked potentials showed P100 latency of 136 msec in the right eye compared to 100 msec in the left eye. Blood sugar levels were within normal limits. Fundus fluorescein angiography revealed a sectorial hyperfluorescence with an intact macula (Fig. 2). Bjerrum's campimetry at 2 m revealed a cecocentral scotoma in the right eye with 10/2000 white. The patient was followed up with nonsteroidal anti-inflammatory agents. By the end of the third month, the macular star had broken up and the hyperemia had resolved. Visual acuity however was only 6/24 unimprovable.

The unilateral macular star with disc edema corroborated by characteristic angiographic picture in the absence of a neurological deficit and a normal CT scan study completes a diagnosis of Leber's idiopathic stellate neuroretinitis. This patient however, did suffer from hypertension, albeit, with no features of affection of hypertension in the eyes, which is at variance with the report of Dreyer et al.²

References

1. Guyer DR, D'Amico DJ : Leber's idiopathic stellate neuroretinitis. In : Principles and practice of ophthalmology. Albert DM, Jakobiec FA (ed.) WB Saunders, Philadelphia, 1994; 2 : 61.
2. Dreyer RF, Hopen G, Gass JDM et al : Leber's idiopathic stellate neuroretinitis. Arch Ophthalmology 1984; 102 : 1140-1145.

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