Abnormal cone synapses in human cone-rod dystrophy

Objective: Little is known of the cytopathology of photoreceptors in human inherited retinal dystrophies that initially affect the central retina, inc luding the macula. The current study sought to determine the cytologic feat ures of dysfunctional cone and rod photoreceptors, as well as the pattern o f degeneration of the cells in representative cases of central retinal dyst rophy, Study Design: Comparative human tissue study. Materials: Four human donor eyes with the following forms of central retina l dystrophy: cone-rod dystrophy (CRD), central areolar choroidal dystrophy, Bardet-Biedl syndrome, and cone dystrophy-cerebellar ataxia. The cytologic features of retinal photoreceptors in these eyes were compared with those in an eye with retinitis pigmentosa and six normal human eyes. Methods and Outcome Measures: Immunocytochemistry and electron microscopy w ere used to evaluate the retinal histopathology in the donor eyes. Results: Cone numbers were decreased in the case of CRD, particularly in th e central and far peripheral retina, and both cone and rod outer segments w ere slightly shortened. Occasional degenerate cones had dense cytoplasm and pyknotic nuclei dislocated sclerad to the external-limiting membrane. The most prominent alteration in this retina was marked enlargement and distort ion of the cone photoreceptor pedicles, which contained reduced numbers of synaptic vesicles. The retina with central areolar choroidal dystrophy cont ained a few cones with similarly abnormal synapses. However, comparable con e synapse abnormalities were not observed in the cases of Bardet-Biedl synd rome, cone dystrophy-cerebellar ataxia, retinitis pigmentosa, or in the nor mal retinas. Conclusions: The functional consequences of the cone synapse abnormalities in CRD are not known but may correlate with the electroretinographic abnorm alities documented in some cases of CRD, To our knowledge, comparable synap se changes have not been noted in either rods or cones in other forms of re tinal dystrophy, including retinitis pigmentosa, suggesting that different cytopathologic mechanisms may be involved.