Clinical course of two siblings with potassium voltage-gated channel modifier subfamily V member 2 (KCNV2)-associated retinopathy

KCNV2-associated retinopathy causes a phenotype reported as “cone dystrophy with nyctalopia and supernormal rod responses (CDSRR; OMIM# 610356),” featuring pathognomonic findings on electroretinography (ERG). Here, we report the clinical courses of two siblings with CDSRR.

Patient 1: A 3-year-old boy with intermittent exophoria was referred to our hospital. The patient’s decimal best-corrected visual acuity (BCVA) at age 6 was 0.7 and 0.7 in the right and left eyes, respectively. Photophobia and night blindness were also observed. Because the ERG showed a delayed and supernormal b-wave with a “squaring (trough-flattened)” a-wave in the DA-30 ERG, and CDSRR was diagnosed. The patient’s vision gradually worsened, and faint bilateral bull’s eye maculopathy was observed at the age of 27 years, although the fundi were initially unremarkable. Genetic examination revealed a homozygous missense variant, c.529T > C (p.Cys177Arg), in the KCNV2 gene.

Patient 2: The second patient was Patient 1’s younger sister, who was brought to our hospital at 3 years of age. The patient presented with exotropia, mild nystagmus, photophobia, night blindness, and color vision abnormalities. The patients’ decimal BCVA at age 13 was 0.6 and 0.4 in the right and left eyes, respectively, and BCVA gradually decreased until the age of 24 years. The fundi were unremarkable. The siblings had similar ERG findings and the same homozygous missense variant in the KCNV2 gene.

The siblings had clinical findings typical of CDSRR. High-intense flash ERG is recommended for identifying pathognomonic “squaring” a-waves in patients with CDSRR.