Peripheral retinal albinotic spots

Torpedo maculopathy: A case series - insights into basic pathology

Torpedo maculopathy is a benign retinal disorder whose pathophysiological origins are currently poorly understood. A number of theories have been postulated, with stable developmental anomalies of the retinal pigment epithelium taking the forefront. Four clinical cases are outlined of patients with macular torpedo lesions, with differing clinical presentation. In all four cases, this reveals very thin retinal pigment epithelium and outer retina associated with the lesion. In a single case, the oldest patient of the group, there is the additional finding of subretinal and intraretinal fluid accumulation. The contrast between this case and the other cases suggests that while initially this benign pathology might start with structurally normal retina with no fluid accumulation, dysgenetic changes in the retinal pigment epithelium might lead to secondary accumulation of fluid over time. Whether indeed this disorder might be progressive in nature, or whether in fact it is a static, non-progressive developmental abnormality as formerly thought, requires further elucidation.

[Hypopigmentation temporal to the macula. Case report: torpedo maculopathy]

A routine examination of the right eye of an asymptomatic 7-year-old boy disclosed slightly prominent, elliptically configured yellowish alterations with irregularly configured central hyperpigmentation temporal to the fovea. On spectral domain optical coherence tomography a well-defined corresponding detachment of the neurosensory retina was identified. The findings are compatible with torpedo maculopathy a rare congenital, usually unilateral lesion Which is normally asymptomatic and shows no progression.

A unique presentation of grouped congenital hypertrophy of the retinal pigment epithelium

PURPOSE

To describe a unique presentation of grouped congenital hypertrophy of the retinal pigment epithelium (CHRPE) and to review the clinical features which differentiate grouped CHRPE from the pigmented ocular fundus lesions (POFLs) associated with familial cancer syndromes.

METHODS

Report of a case.

RESULTS

A 28-year-old asymptomatic, Caucasian female demonstrated multiple small, flat, dark brown to black clusters of retinal pigment epithelium (RPE) hypertrophy on dilated fundus examination of both eyes. These plaque-like lesions were circumferential along the peripheral fundus and were associated with smaller foci of pigmentation oriented towards the posterior pole. The appearance was consistent with grouped pigmented CHRPE. A unique, co-existing feature was the presence of non-pigmented, punctate lesions located within the maculae suggestive of grouped non-pigmented CHRPE. Fluorescein angiography demonstrated persistent hypofluorescence correlating with the clinically observed areas of hyperpigmentation and hypopigmentation.

CONCLUSIONS

The combination of both pigmented and non-pigmented lesions occurring in the same individual with grouped CHRPE is rare. It is important to distinguish grouped CHRPE lesions from the POFLs associated with familial cancer syndromes.

Indocyanine green angiography pattern of congenital grouped albinotic retinal pigment epithelial spots

Congenital grouped albinotic retinal pigment epithelial spots (CGARPES) is a rare retinal pigment epithelium disease with multiple, white spots, generally involving the peripheral retina, with variable angiographic pattern. A 46-year-old male affected by CGARPES underwent fluorescein angiography and indocyanine green videoangiography. Fluorescein angiography demonstrated an early hyperfluorescence of the spots. A peculiar pattern was revealed by indocyanine green videoangiography. Indeed, during the early phases the spots were either not detectable on the choroidal background, or presented slightly hypofluorescent, whereas during the intermediate and the late phases some spots became progressively hyperfluorecent. The angiographic behavior on indocyanine green may be explained considering a gradual staining of the lesions, with a progressive binding between the indocyanine green molecule and the abnormal retinal pigment epithelium material.

[Congenital grouped albinotic spots: a case report]

INTRODUCTION

Case report of congenital grouped albinotic spots.

OBSERVATION

A 24-year-old woman was referred for frontal headache related to +1.50 hypermetropia. Visual acuity was 20/20 in both eyes. During routine examination, fundus examination revealed multiple, irregular white spots involving the juxtapapillary and peripheral retina in both eyes. Color vision, visual fields, and electroretinographic findings were normal. Fluorescein angiograms showed hyperfluorescent spots; indocyanine green (ICG) showed hypofluorescence of these lesions.

CONCLUSION

These albinotic spots are uncommon benign developmental lesions of the retinal pigment epithelium; they appear to represent focal thickening of the retinal pigment epithelium (RPE) that is filled with white material, possibly an abnormal precursor of melanin.

Paramacular coloboma

BACKGROUND

Paramacular coloboma (plural: colobomata) is a solitary oval football or torpedo-shaped chorioretinal lesion located temporal to the fovea in one or both eyes. Previous case reports have speculated varying etiology, but few have justified its pathognomonic shape and location. We believe it to be congenital in nature and caused by incomplete differentiation of the arcuate bundles along the horizontal raphe in development of the macular architecture. Associated ocular findings may include blepharophimosis, situs inversus, or other anomalous retinal vascular patterns.

CASE REPORTS

Three cases of asymptomatic unilateral paramacular colobomata are presented. In each case, a single oval chorioretinal lesion temporal to the macula was found during routine examination. Visual acuity and Humphrey threshold visual field testing were normal with no other associated congenital, systemic, or ocular abnormalities. Because the lesion is nonprogressive, these patients can be followed on an annual basis.

CONCLUSION

Due to their anatomical origin, paramacular colobomata are always located temporal to the macula and have an oval football-shaped appearance. Visual acuity and visual field testing are usually normal, although highly observant patients may be aware of a mild scotoma. Differential diagnosis is important because the clinical appearance can be similar to acquired conditions, most notably age-related macular degeneration and presumed ocular histoplasmosis syndrome.

Focal congenital anomalies of the retinal pigment epithelium

The terms, 'hamartoma', 'choristoma', 'phacoma' (mother-spot), and 'naevus', are used to describe benign developmental tumours or placoid lesions. Stedman's Medical Dictionary defines a hamartoma as: 'A focal malformation that resembles a neoplasm grossly and even microscopically, but results from faulty development in an organ; it is composed of an abnormal mixture of tissue elements, or an abnormal proportion of a single element, normally present in that site, which develop and grow at virtually the same rate as normal components, and are not likely to result in compression of the adjacent tissue (in contrast to neoplastic tissue).' A choristoma is defined as 'a mass formed by maldevelopment of tissue of a type not normally found at that site.' Phacoma is defined as, 'a hamartoma found in phacomatosis,' a group of hereditary diseases characterised by hamartomas of multiple tissues. A naevus is a, 'birthmark; a circumscribed malformation of the skin, especially if coloured by hyperpigmentation or increased vascularity; it may be predominantly epidermal, adnexal, melanocytic, vascular, or mesodermal, or a localised overgrowth of melanin-forming cells arising in the skin early in life.' Ophthalmologists have adopted the term to refer to developmental melanocytic lesions of the uveal tract, but heretofore have not used it to describe developmental melanocytic, glial, or vascular lesions of the retina. The purpose of this report is to summarise the author's observations and concepts concerning focal lesions that probably are developmental tumours and placoid lesions composed of either entirely or in part retinal pigment epithelium (RPE). Two of the lesions are tumefactions and may properly be termed 'hamartomas'. Four of the lesions are placoid and might better be described as naevi. Two are composed of hypertrophied RPE cells engorged with melanin granules, one is presumed to be hypertrophied RPE cells filled with a white pigment of unknown nature and one is composed of RPE cells containing no pigment. Three are widely recognised, three others are not.

Pigmented ocular fundus lesions in the inherited gastrointestinal polyposis syndromes and in hereditary nonpolyposis colorectal cancer

The authors studied pigmented ocular fundus lesions in three different forms of hereditary gastrointestinal polyposis and in hereditary nonpolyposis colorectal cancer. Congenital hypertrophy of the retinal pigment epithelium (CHRPE) was present in at least one member of 23 families with Gardner's syndrome. By contrast, CHRPE was not found in three families with familial polyposis coli, four families with hereditary nonpolyposis colorectal cancer, and three families with Peutz-Jeghers syndrome. Pigmented ocular fundus lesions of the CHRPE-type appear to be specific to Gardner's syndrome among inherited diseases with gastrointestinal polyposis.

Amelanotic choroidal nevi

A review of 373 patients with presumed choroidal nevi revealed 19 (5.1%) to have largely or totally amelanotic nevi. All patients but one with amelanotic nevi were white, and all were 48 years of age or older. Each lesion was located posterior to the equator, had a mean diameter of 3.2 mm, and was less than or equal to 1 mm in elevation. Intravenous fluorescein angiography most often disclosed early and late hyperfluorescence, corresponding to the amelanotic areas of the nevus. No lesions were observed to grow during a mean 14-month follow-up period. The differential diagnosis of amelanotic nevi of the choroid is discussed and includes amelanotic malignant melanoma, cavernous hemangioma of the choroid, metastatic cancer to the choroid, posterior scleritis, choroidal osteoma, and hypopigmented congenital hypertrophy of the retinal pigment epithelium.