Gyrate atrophy of the choroid and retina with hyperornithinaemia, cystinuria and lysinuria

Abstract

The case of a 45-year-old woman with gyrate atrophy of the choroid and retina is documented. Additional features in this case, to the authors’ knowledge not previously described in gyrate atrophy, are massive cystinuria, massive lysinuria, axial hypermetropia and diabetes. Gyrate atrophy is a rare autosomal recessive degenerative disease of the choroid and retina and is accompanied by defective ornithine metabolism. Simell and Takki1 demonstrated the association with hyperornithinaemia in 1973. The main metabolic features are those of hyperornithinaemia and ornithuria caused by a deficiency of the mitochondrial matrix enzyme, ornithine aminotransferase (OAT).2—4 The responsible human gene has been localised to chromosome 10.5 Despite the generalised deficiency of OAT, the literature indicates significant pathological involvement of the eye only.6 Ophthalmological features of the disease are myopia (up to 10—20 dioptres), night blindness, constricted visual fields and complicated cataracts.7 The clinical picture has been detailed previously by various authors.8,9The case of a 45-year-old woman with gyrate atrophy and hyperornithinaemia is documented here. She has been followed up for 12 years and fully investigated. Additional features in this case, to our knowledge not previously described in gyrate atrophy, are massive cystinuria, massive lysinuria, axial hypermetropia and diabetes. © 1994 Royal College of Ophthalmologists.