Purpose
To define characteristic ocular features in a group of patients with autosomal recessive (AR)
PROM1
cone-rod dystrophy (CRD).
Methods
Three males and one female from three unrelated families were first seen at the ages of 15 to 22 years and diagnosed with CRD. Clinical testing available for review included full-field electroretinogram (ERG) in three patients, as well as near-infrared autofluorescence (NIR-AF), spectral-domain optical coherence tomography (SD-OCT), and color fundus photography in all four patients. Whole exome sequencing (WES) was performed on all cases, and whole genome sequencing (WGS) was performed in two families.
Results
WES found compound heterozygous
PROM1
variants in one isolated male, plus heterozygous variants in the remaining patients. WGS uncovered deleterious
PROM1
variants in these two families. ERG showed markedly reduced cone-isolated amplitudes and variably reduced rod-isolated amplitudes. The dark-adapted combined rod and cone responses demonstrated notably reduced a-wave amplitudes and moderately reduced b-waves, and the resultant waveform resembled the normal rod-isolated response. On fundus examination, oval-shaped macular lesions were observed, as were several small, circular hypoautofluorescent lesions within the posterior pole on NIR-AF. Three patients showed extramacular circular atrophic lesions.
Conclusions
The autofluorescence changes, peripheral retinal abnormalities, and ERG findings have not been emphasized in previous reports of AR
PROM1
, but they became a recognizable phenotype in this cohort of patients. A similar constellation of findings may be observed in CRD due to
CDHR1,
a functionally related gene. The pattern of abnormalities reported herein may help to focus genetic screening in patients with these findings.