Dysfunction of transmission in the inner retina: incidence and clinical causes of negative electroretinogram

Background Only limited data exist on the incidence of negative electroretinograms (ERG) in clinical practice. The purpose of this study is therefore to determine the incidence and clinical causes of a negative ERG in a tertiary care centre focused on inherited and acquired retinal degenerations. Methods All ERGs recorded (in accordance with ISCEV standards) in our electrophysiological laboratory from 1992 to 2004 were retrospectively reviewed. The negative ERGs (criterion: ERG with b:a wave ratio≤1 in the scotopic standard combined response in at least one eye) were analysed in the context of further clinical results. The photopic ON- and OFF-responses were recorded with long duration (200 ms) stimuli. Results A total of 1999 ERGs from 1644 patients were performed during the study period. 47/1644 patients (2.9%) presented with a negative ERG and were included in the study. Clinical diagnoses included inherited retinal dystrophies [X-linked congenital retinoschisis (XRS) (n=17), congenital stationary night blindness (CSNB) (n=6), retinitis pigmentosa (RP) (n=6), cone (-rod) dystrophy (n=5), choroideremia (n=1), Müller cell sheen dystrophy (MCSD) (n=1)] and acquired retinopathies (melanoma-associated retinopathy (MAR) (n=1), vigabatrin retinotoxicity (n=1)). In nine patients a definitive diagnosis could not be established. Unilateral negative ERGs were seen in 10/37 patients where ERG was bilaterally recorded. The fellow eye presented with a b:a wave ratio >1 (8 eyes) or ERG responses were not detectable (2 eyes). Photopic ON- and OFF-responses were recorded in 38 eyes of 29 patients and 32/38 eyes presented with a negative ERG. The ON-response was reduced in 25/32 eyes, whereas the OFF-response was reduced in only 11/32 eyes. Conclusions The incidence of a negative ERG can differ between the laboratories depending on the causes for ERG recording and was in our laboratory 2.9% in a consecutive series of patients with inherited or acquired retinal degenerations. A disorder characteristically associated with negative ERG (e.g. XRS, CSNB, MAR) was diagnosed in 53% of these patients, whereas in 47% the negative ERG indicated an unexpected post-receptoral dysfunction, e.g. in cone (-rod) dystrophy or RP. The ON-bipolar pathway was affected in most cases. Presented in part at the 103rd annual meeting of the German Society of Ophthalmology (DOG), September 2005, Berlin, Germany. Supported in part by the Deutsche Forschungsgemeinschaft, Bonn, Germany (grant no.: Ke442/11-1,2).