Gyrate atrophy of the choroid and retina: Update on diagnosis and treatment

Abstract

Gyrate atrophy of the choroid and retina (GACR) is a rare autosomal recessive disease characterised by elevated plasma ornithine levels due to deficiency of the enzyme ornithine aminotransferase (OAT). The accumulation of this amino acid in plasma leads to the development of patches of chorioretinal atrophy in the peripheral retina extending into the macular area. Patients usually present with night blindness followed by constriction of the visual field and, finally, decreased central vision and blindness. The disease is diagnosed by the presence of the characteristic clinical picture, the presence of hyperornithinaemia in plasma and the detection of mutations in the OAT enzyme gene. There is currently no effective gene therapy and the most common therapeutic intervention mainly involves dietary modifications with arginine restriction. This article aims to summarise the pathogenesis, clinical and diagnostic findings and treatment options in patients with GACR.

Keywords: Atrofia girata; Distrofias retinianas; Enfermedades raras; Errores congénitos del metabolismo; Gyrate atrophy; Inborn errors of metabolism; OAT; Oftalmología; Ophthalmology; Rare diseases; Retina; Retinal dystrophies.