Gyrate atrophy of the choroid and retina: a tertiary center experience

TL;DR

This study shares clinical experience with gyrate atrophy, a rare eye disorder linked to amino acid metabolism, focusing on treatment approaches and patient outcomes.

Contribution

The paper provides a tertiary center's clinical experience and treatment strategies for gyrate atrophy of the choroid and retina.

Findings

Seven patients with GACR were managed with an arginine-restricted diet and various supplements.

Ophthalmological treatments were tailored to individual patients, focusing on reducing cystoid macular edema.

Early diagnosis and multidisciplinary care are emphasized for better outcomes.

Abstract

Gyrate atrophy of the choroid and retina (GACR) is a rare amino acid metabolism disorder. Night blindness, cataracts, vision loss, and impaired cognitive functions can be seen. An arginine-restricted diet, combined with pyridoxine, lysine, proline, or creatine supplementation, can be used in conjunction with treatments for ophthalmological findings.

Patients followed by the Gazi University Faculty of Medicine, Department of Pediatric Metabolism and Nutrition, and Department of Ophthalmology who were genetically or biochemically diagnosed with GACR were included in the study. The patients’ medical records were retrospectively reviewed between 2000 and 2023.

Seven patients with a mean age of 18.08 ± 8.6 years and a mean age at diagnosis of 10.4 ± 5.6 years were included. The earliest diagnosed patient was 15 months old. All patients had high plasma ornithine levels at the time of diagnosis, and they were all started on an arginine-restricted diet. Ophthalmological treatments were decided on a patient-specific basis.

GACR is easily recognizable, but there is still no consensus on treatment modalities. The patients primarily present with progressive ophthalmological findings. An arginine-restricted diet is combined with supplementation with pyridoxine, lysine, proline, or creatine to improve metabolic control. Ophthalmological treatments are mainly applied to reduce cystoid macular edema. Early diagnosis and early initiation of therapy should be aimed at patients, and a multidisciplinary approach should be demonstrated both in diagnosis and follow-up.

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