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Novel clinical presentation of a CRX rod-cone dystrophy
  1. Luis Alonso Gonzalez-Gonzalez1,2,
  2. Hannah Scanga2,
  3. Elias Traboulsi3 and
  4. Ken K Nischal4
  1. 1Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
  2. 2Ophthalmology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
  3. 3Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, USA
  4. 4Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Professor Ken K Nischal; nischalkk{at}


We describe a novel clinical presentation of a CRX rod-cone dystrophy in a single family. Two boys ages 6 and 12 years presented with clinical and optical coherence tomography features suggestive of X-linked retinoschisis, but with optic nerve swelling without increased intracranial pressure. One patient had an electronegative electroretinogram (ERG) and the other had rod-cone dysfunction. Neither had retinoschisin (RS1) gene mutations. Biological mother and sister presented with retinal pigment epithelium (RPE) changes and abnormal cone-rod ERG responses. On further testing, next generation sequencing with array comparative genomic hybridisation showed a deletion in exon 4 of the CRX gene. Cystoid maculopathy in young male children can be difficult to distinguish from RS1-associated schisis. Phenotypic variants within a family must prompt a thorough retinal dystrophy evaluation even with electronegative ERG in the presenting child. This novel phenotype for CRX presents with optic nerve swelling and cystoid maculopathy in men, and RPE changes in women.

  • genetics
  • ophthalmology
  • macula
  • retina

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  • Twitter @nischalkk

  • Contributors KKN devised the project and the main conceptual ideas. KKN and LAGG worked out the proof outline, performed the review of medical records and wrote the case series. HS performed the genetic counselling, informed consents and critical review of the manuscript. ET contributed by reviewing the manuscript and making great contributions to the analysis and discussion.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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