Título

BENIGN CONCENTRIC ANNULAR MACULAR DYSTROPHY: CASE REPORT

Objetivo

Describe a rare case of Benign Concentric Annular Macular Dystrophy (BCAMD), detailing the main findings and how to proceed in order to perform the correct differential diagnosis with other maculopathies with “bull's eye” and worse visual prognosis, such as chloroquine toxicity and hydroxychloroquine, Stargardt's Disease, Choroidal Central Areolar Atrophy, Chronic Macular Hole and Cone Dystrophy.

Relato do Caso

E.R.B, 58, caucasian man, comes for a regular medical appointment. He denied worsening of vision or other symptoms. Reported being diabetic with the disease controlled with metformin, denied any other comorbidities or prolonged use of other medications throughout life. There are no relevant data on the family history. On ophthalmologic examination, presented vision with correction 20/20 in both eyes (BE). Anterior segment examination and intraocular pressures were normal. Fundoscopy showed a concentric hypopigmentation ring (bull's eye) in the fovea in BE. As complementary exams, Fluorescein Angiography (AFG), Autofluorescence, Optos California Ultra-Widefield Retinography (UWF) and Ishihara Test were performed. The AFG showed a window defect with a speckled appearance, which is a common sign both in BCAMD and in Stargardt, but in the latter there is Choroidal Silence and yellowish lesions called “flecks”. Autofluorescence showed an area of hypoautofluorescence in a ring concentric shape and a slightly hypoautofluorescent fovea in AO, with a discrete hyperfluorescent halo. The UWF presented changes in central macular brightness with hypopigmentation in a 360 degree perimacular halo (Bull's Eye appearance). Ishihara's test did not reveal dyschromatopsia. Analyzing all these findings, it was possible to make the diagnosis of BCAMD, keeping the patient in biannual outpatient follow-up.

Conclusão

The prognosis of BCAMD it's usually good, therefore it is most important to make an accurate diagnosis using anamnesis data and these range of exams to distinguish it from others entities with “bull's eye” pattern and thus take the correct conduct.