26doc120 10.3205/26doc120 urn:nbn:de:0183-26doc1206 Meeting Abstract Gavazi Gavazi Jona J

Brown University, Providence, USA

author Dhrami Dhrami Elona E

University of North Dakota, Grand Forks, USA

author German Medical Science GMS Publishing House

Düsseldorf

610 20260617 engl This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). M0651 120 38. Internationaler Kongress der Deutschen Ophthalmochirurgie (DOC) Glaukom Nürnberg 20260618 20260620 EPO 2.4 TextPurpose: To report a case of Retinitis Pigmentosa (RP) managed as Juvenile Open-Angle Glaucoma (JOAG) for twelve years and to highlight the “diagnostic paradox” of progressive peripheral field loss in the presence of a healthy retinal nerve fiber layer (RNFL).Methods: A 30-year-old male presented for a second opinion regarding refractory glaucoma. He had been maintained on topical Timolol since age 18 based on constricted visual fields. Comprehensive evaluation included intraocular pressure (IOP) monitoring, gonioscopy, wide-field fundus photography, fundus autofluorescence (FAF), and spectral-domain OCT (SD-OCT) and full-field electroretinography (ffERG).Results: Clinical examination revealed consistently normal IOPs and an open, healthy angles on gonioscopy. Optic nerves remained pink and healthy, showing no glaucomatous cupping or waxy pallor. Wide-field imaging and FAF confirmed a classic RP phenotype: peripheral bone-spicule pigmentation and arteriolar attenuation. FAF showed a striking contrast between a hyper-autofluorescent inferior macular ring and a dense, confluent zone of peripapillary and peripheral hypo-autofluorescence, representing profound RPE atrophy that correlated with the severe visual field constriction. Notably, SD-OCT confirmed that the RNFL thickness remained entirely within normal limits (360° green classification), creating a structural-functional “paradox” relative to the constricted fields. Macular OCT demonstrated profound outer retinal thinning and ellipsoid zone loss. Diagnosis was confirmed by ffERG, which showed extinguished scotopic and photopic responses. The patient was transitioned to genetic counseling.Conclusion: This case illustrates that RP can present as a “pseudo-glaucoma”, where peripheral field constriction is erroneously attributed to optic neuropathy. The preservation of a healthy RNFL and normal gonioscopy, even in the setting of severe field loss, is a critical diagnostic sentinel that should prompt immediate investigation of the retina. This report emphasizes that multimodal imaging is essential to prevent protracted pharmacological mismanagement and to facilitate appropriate hereditary counseling. 0 0 0 0