Atypical COQ2-related retinopathy in identical twins with nephropathy mimicking intermediate uveitisGavrič, Ana Uršula (Avtor) Volk, Marija (Avtor) Kojc, Nika (Avtor) Osredkar, Damjan (Avtor) Meglič, Andrej (Avtor) Šuštar Habjan, Maja (Avtor) Kiraly, Peter (Avtor) Jaki Mekjavić, Polona (Avtor) COQ2-related retinopathyuveitisrare diseasePurpose: To describe an atypical presentation of COQ2-related retinopathy in identical twins withnephropathy, mimicking intermediate uveitis with cystoid macular oedema (CMO).Methods: Retrospective case report.Results: A 33-year-old man presented with bilateral vision worsening and suspected intermediate uveitis.Examination revealed vitreous cells, CMO, retinal microangiopathy, and severely abnormal electrooculo-graphy (EOG) with only borderline full-field electroretinography (ERG) changes. CMO worsened withtopical corticosteroids but improved bilaterally after a single unilateral intravitreal bevacizumab injection,suggesting a systemic therapeutic effect. His identical twin exhibited very similar retinal and systemicfindings. Whole-exome sequencing identified a homozygous likely pathogenic COQ2 variant (c.683A >G), confirming primary coenzyme Q10 (CoQ10) deficiency type 1. Both twins also had nephropathyconsistent with focal segmental glomerulosclerosis (FSGS) but no neurological involvement.Conclusions: This report expands the phenotypic spectrum of COQ2-related retinopathy, characterizedby retinal microangiopathy, CMO, and primary retinal pigment epithelium (RPE) dysfunction with pre-served rod function, in contrast to the typical retinitis pigmentosa–like phenotype. Recognition of thispresentation is critical, as early CoQ10 supplementation may stabilize disease progression and preventsystemic complications. Genetic testing should be considered in young patients with CMO resemblingintermediate uveitis, particularly when associated with nephropathy.20262026-08-18 09:41:13Neznano31914sl