A 9-Year-Old Boy With Strabismus, Anisometropic Amblyopia, and Myopia in the Left Eye, Associated With Myelinated Retinal Nerve Fibers Syndrome, Managed With Multimodal Therapy.

BACKGROUND Myelinated retinal nerve fibers (MRNF) syndrome is a rare, benign congenital condition in which white nerve fibers can be seen extending from the optic nerve to involve the retina. The condition is usually asymptomatic, but some cases of MRNF syndrome are associated with axial myopia, amblyopia (lazy eye), and strabismus (squint). This report describes the case of a 9-year-old boy with strabismus, anisometropic amblyopia, and MRNF-associated myopia in the left eye, managed with multimodal therapy and evaluated with pattern visual evoked potential (PVEP) testing. CASE REPORT A 9-year-old boy with MRNF presented with left eye exotropia, high myopia, and amblyopia. After 3.5 years of limited improvement with part-time occlusion, an intensified multimodal treatment was initiated, including full-time occlusion, low-level red light therapy (650 nm), red flicker therapy (630 nm), accommodative training, eye-tracking training, and afterimage therapy. Following a 2-month period of therapy, the patient's left eye best-corrected visual acuity improved from 20/80 to 20/30, with associated improvements in axial length and PVEP. Myopia progression was controlled and strabismus improved from 12° to 5°. CONCLUSIONS This report highlights the conditions that may be associated with MRNF syndrome. Although there is no treatment for MRNF, a multimodal approach to associated symptoms can be effective with careful monitoring and follow-up.