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Khadamy J, Elmi Sadr N. Multifocal Congenital Simple Hamartoma of the Retinal Pigment Epithelium: A Multimodal Imaging Case Study. Cureus 2024; 16:e60755. [PMID: 38903341 PMCID: PMC11188573 DOI: 10.7759/cureus.60755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 06/22/2024] Open
Abstract
Congenital simple hamartoma of the retinal pigment epithelium (CSHRPE) is a rare benign tumor often detected incidentally during routine eye exams. We present a case of multifocal CSHRPE in a 32-year-old Hispanic woman, emphasizing the diagnostic challenges posed by its presentation and the pivotal role of multimodal imaging in accurate diagnosis. Despite initial difficulties due to a history of trauma and pigmented fundus, advanced imaging techniques, including optical coherence tomography (OCT), OCT angiography (OCTA), fluorescein angiography (FA), and indocyanine green angiography (ICGA), facilitated a precise diagnosis. Notably, OCTA revealed high signal intensity and flow at the largest nodule site while FA and ICGA exhibited characteristic blockage patterns. Moreover, smaller nodules exhibited OCT findings supporting the theory of islands of retinal pigment epithelium (RPE) cells proliferating ectopically within the retina. Our case underscores the importance of comprehensive imaging assessment in distinguishing CSHRPE from other lesions, contributing to a deeper understanding of this rare ocular condition.
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Affiliation(s)
- Joobin Khadamy
- Ophthalmology, Skellefteå Eye Clinic, Skellefteå, SWE
- Ophthalmology, University Hospital of Umeå, Umeå, SWE
| | - Navid Elmi Sadr
- Ophthalmology, Semnan University of Medical Sciences, Semnan, IRN
- Clinical Research Development Unit, Kowsar Educational, Research and Therapeutic Hospital, Semnan University of Medical Sciences, Semnan, IRN
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2
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Coussa RG, Mansoor M, Boldt HC, Binkley EM. Nonpigmented Adenoma of the Retinal Pigment Epithelium Mimicking a Retinal Vasoproliferative Tumor Managed With Endoresection. JOURNAL OF VITREORETINAL DISEASES 2024; 8:343-348. [PMID: 38770086 PMCID: PMC11102728 DOI: 10.1177/24741264241240332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Purpose: To present a case with signs suggestive of a retinal vasoproliferative tumor. Methods: A case report was evaluated and a surgical video presented. Results: A 61-year-old White man presented with an amelanotic retinal tumor associated with exudation, retinal edema, and overlying telangiectatic vessels, suggestive of a retinal vasoproliferative tumor. Standardized echography showed an irregular mass with medium-to-high internal reflectivity and internal calcification, which suggested chronicity. He was initially treated for an exudative retinal detachment (RD) in the context of a presumed vasoproliferative tumor but later developed combined exudative and rhegmatogenous RD, prompting surgical repair with tumor endoresection. Pathology showed nonpigmented adenoma of the retinal pigment epithelium (RPE). Conclusions: Nonpigmented adenoma of the RPE is a rare tumor, and its clinical similarity to a vasoproliferative tumor should be noted. Endoresection may be considered in cases resulting in RD.
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Affiliation(s)
- Razek G. Coussa
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
- Dean McGee Eye Institute, University of Oklahoma College of Medicine, Oklahoma City, OK, USA
| | - Mahsaw Mansoor
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
| | - H. Culver Boldt
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
- Institute for Vision Research, University of Iowa, Iowa City, IA, USA
| | - Elaine M. Binkley
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
- Institute for Vision Research, University of Iowa, Iowa City, IA, USA
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3
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Yasvoina M, Yang Q, Woods SM, Heeren T, Comer GM, A Egan C, Fruttiger M. Intraretinal pigmented cells in retinal degenerative disease. Br J Ophthalmol 2023; 107:1736-1743. [PMID: 35301216 DOI: 10.1136/bjophthalmol-2021-320392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/28/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE Invasion of pigmented cells into the retina occurs in retinal degenerative diseases, such as macular telangiectasia type 2 (MacTel) and retinitis pigmentosa (RP). These intraretinal pigmented cells may be derived from the retinal pigment epithelium (RPE), but differences and similarities between intraretinal pigmented cells and RPE have so far not been well characterised.Clinicopathologic case report. METHOD Here, we compared intraretinal pigment cells with RPE cells by immunohistochemistry. Immunohistological stains for classic RPE markers (RPE65, CRALBP and KRT18) and blood vessel markers (lectin and collagen 4) were done on sections from postmortem eye tissue from two MacTel donors, an RP donor and a control donor. MAIN OUTCOME MEASURES Presence of specific immunohistochemistry markers on intraretinal pigmented and RPE cells. RESULTS We found that intraretinal pigmented cells did not express RPE65 and CRALBP, with a small subset expressing them weakly. However, they all expressed KRT18, which was also present in normal RPE cells. Interestingly, we also found clusters of KRT18-positive cells in the retina that were not pigmented. CONCLUSIONS Our findings suggest that RPE cells invading the retina dedifferentiate (losing classic RPE markers) and can be pigmented or unpigmented. Therefore, the number of RPE cells invading the retina in retinal degenerative disease may be underappreciated by funduscopy.
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Affiliation(s)
- Marina Yasvoina
- UCL Institute of Ophthalmology, University College London, London, UK
| | - Qian Yang
- UCL Institute of Ophthalmology, University College London, London, UK
| | - Sasha M Woods
- UCL Institute of Ophthalmology, University College London, London, UK
| | - Tjebo Heeren
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Grant M Comer
- W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Marcus Fruttiger
- UCL Institute of Ophthalmology, University College London, London, UK
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4
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Sharma A, Wu L, Bloom S, Stanga P, Khaqan HA, Garcia-Aguirre G, Cheung JY, Rezaei KA. RWC Update: Intruding Scleral Buckle; Vitrectomy for Floaters; Group-Type Congenital Pigmented Nevi of the RPE. Ophthalmic Surg Lasers Imaging Retina 2023; 54:500-503. [PMID: 37708226 DOI: 10.3928/23258160-20230817-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
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5
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High-Resolution Spectral Domain Optical Coherence Tomography of Congenital Grouped Albinotic Spots. Retina 2022; 42:e41-e42. [DOI: 10.1097/iae.0000000000003552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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6
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Vienola KV, Dansingani KK, Eller AW, Martel JN, Snyder VC, Rossi EA. Multimodal Imaging of Torpedo Maculopathy With Fluorescence Adaptive Optics Imaging of Individual Retinal Pigmented Epithelial Cells. Front Med (Lausanne) 2021; 8:769308. [PMID: 34957148 PMCID: PMC8698897 DOI: 10.3389/fmed.2021.769308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/08/2021] [Indexed: 12/03/2022] Open
Abstract
Torpedo maculopathy (TM) is a rare congenital defect of the retinal pigment epithelium (RPE). The RPE is often evaluated clinically using fundus autofluorescence (AF), a technique that visualizes RPE structure at the tissue level from the intrinsic AF of RPE fluorophores. TM lesions typically emit little or no AF, but this macroscopic assessment is unable to resolve the RPE cells, leaving the organization of the RPE cell mosaic in TM unknown. We used fluorescence adaptive optics scanning laser ophthalmoscopy (AOSLO) to show here for the first time the microscopic cellular-level structural alterations to the RPE cell mosaic in TM that underlie the tissue-level changes seen in conventional clinical imaging. We evaluated two patients with TM using conventional clinical imaging techniques and adaptive optics (AO) infrared autofluorescence (IRAF) in AOSLO. Confocal AOSLO revealed relatively normal cones outside the TM lesion but altered cone appearance within it and along its margins in both patients. We quantified cone topography and RPE cell morphometry from the fovea to the margin of the lesion in case 1 and found cone density to be within the normal range across the locations imaged. However, RPE morphometric analysis revealed disrupted RPE cells outside the margin of the lesion; the mean RPE cell area was greater than two standard deviations above the normative range up to approximately 1.5 mm from the lesion margin. Similar morphometric changes were seen to individual RPE cells in case 2. Multi-modal imaging with AOSLO reveals that RPE cells are abnormal in TM well beyond the margins of the characteristic TM lesion boundary defined with conventional clinical imaging. Since the TM fovea appears to be fully formed, with normal cone packing, it is possible that the congenital RPE defect in TM occurs relatively late in retinal development. This work demonstrates how cellular level imaging of the RPE can provide new insight into RPE pathologies, particularly for rare conditions such as TM.
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Affiliation(s)
- Kari V Vienola
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kunal K Dansingani
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andrew W Eller
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Joseph N Martel
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Valerie C Snyder
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ethan A Rossi
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA, United States.,McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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7
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Pimentel SLG, Conci LS, Lima LH, Balaratnasingam C, Yannuzzi LA, Shields CL. MACULAR EDEMA IN A PECULIAR CASE OF PIGMENTARY MACULOPATHY. Retin Cases Brief Rep 2021; 15:S11-S20. [PMID: 34171897 DOI: 10.1097/icb.0000000000001146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Sergio L G Pimentel
- Department of Ophthalmology, University of São Paulo (USP), São Paulo, Brazil
| | - Lívia S Conci
- Department of Ophthalmology, University of São Paulo (USP), São Paulo, Brazil
| | - Luiz H Lima
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Chandrakumar Balaratnasingam
- Center for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
- Department of Ophthalmology, Sir Charles Gairdner Hospital, Western Australia, Australia
| | | | - Carol L Shields
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
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8
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Zola M, Ambresin A, Zografos L. OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IMAGING OF A CONGENITAL SIMPLE HAMARTOMA OF THE RETINAL PIGMENT EPITHELIUM. Retin Cases Brief Rep 2021; 15:289-293. [PMID: 30074568 DOI: 10.1097/icb.0000000000000788] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the case of a small pigmented tumor in the macular region investigated using optical coherence tomography angiography (OCT-A) in the context of a multimodal approach. METHODS Case report. RESULTS A 24-year-old man was referred for evaluation of an asymptomatic unilateral round comma-shaped pigmented tumor located in the macular region of his right eye. Spectral-domain OCT revealed an irregular hyperreflective mass within the retina, with a thickened hyaloid membrane and abrupt margins, and a complete posterior shadowing effect. On fluorescein angiography, early hyperfluorescence without leakage in the middle and late phases and a subtle halo of hyperfluorescence in the late phase were observed. OCT-A revealed the presence of intrinsic vascularization at the level of the inner capillary plexus, with signal intensity present at the level of the outer capillary plexus. In the superficial scans, the retinal vessels were oriented radially to the lesion and were in continuity with the vascular network within the tumor mass. No choroidal vessels could be identified. CONCLUSION We report the case of a congenital simple hamartoma of the retinal pigment epithelium investigated using OCT-A as part of multimodal imaging. OCT-A provided a new insight in the assessment of the lesion, differential diagnosis, and follow-up of the patient. This imaging modality could be an important non-invasive tool in the management of congenital hamartomas of the retinal pigment epithelium.
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Affiliation(s)
- Marta Zola
- Department of Ophthalmology, Jules Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
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9
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Marques JP, Neves ER, Farinha C, Silva R. Congenital Grouped Albinotic Spots: New Insights on the Pathophysiology Based on Multimodal Retinal Imaging. Ophthalmic Surg Lasers Imaging Retina 2021; 51:236-238. [PMID: 32348540 DOI: 10.3928/23258160-20200326-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 02/25/2020] [Indexed: 11/20/2022]
Abstract
The terms "congenital grouped albinotic spots" (CGAS) and "polar bear tracks" refer to a rare, benign retinal disorder of unknown etiology characterized by multiple, predominantly unilateral, variably sized, well-circumscribed, flat white retinal spots organized in groups. To date, very few cases of CGAS have been reported. The authors describe a case of CGAS thoroughly characterized by multimodal imaging over an 8-year follow-up, aiming to provide new insights on the pathophysiology of this entity. This is the first report where a long follow-up combined with up-to-date imaging technology is used to characterize CGAS. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:236-238.].
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10
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Diagnostic and Therapeutic Challenges. Retina 2021; 41:882-885. [PMID: 31913189 DOI: 10.1097/iae.0000000000002749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Menezes K, Mancera N, Patel H, Kattih Z, Mhaskar R. Torpedo Maculopathy: A Systematic Review of Case Reports. Ophthalmic Surg Lasers Imaging Retina 2021; 52:78-83. [DOI: 10.3928/23258160-20210201-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 01/05/2021] [Indexed: 11/20/2022]
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12
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Goel S, Nangia P, Rijey AJ, Saurabh K, Roy R. An unusual presentation of macular telangiectasia type 2 with a large pigment deposit. GMS OPHTHALMOLOGY CASES 2021; 11:Doc03. [PMID: 33654650 PMCID: PMC7894179 DOI: 10.3205/oc000176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Macular telangiectasia type 2 (MacTel) is a bilateral retinal disease that seems to be limited to the juxtafoveal region of the macula. We herein report an unusual presentation of MacTel with a large pigment deposit at the macula. Fundus of the right eye showed a large pigment deposit at the macula and right-angled venule. The left eye fundus showed a grayish discoloration due to subretinal fibrosis, dark pigment clumps and right-angled venule in the macula. Lesions were highlighted on multicolor imaging and blue reflectance imaging. Spectral domain optical coherence tomography (SD-OCT) of both eyes showed hyperreflectivity on the inner aspect of the retina corresponding to the area of pigment clumping.
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Affiliation(s)
- Sugandha Goel
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
| | - Purna Nangia
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
| | - A. Joash Rijey
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
| | - Kumar Saurabh
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India
| | - Rupak Roy
- Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, Kolkata, West Bengal, India,*To whom correspondence should be addressed: Rupak Roy, Department of Vitreo Retina, Aditya Birla Sankara Nethralaya, 147 Mukundapur, E. M. Bypass, Kolkata 700099, West Bengal, India, Phone: +91 33 4401 3000, E-mail:
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13
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Liu Y, Moore AT. Congenital focal abnormalities of the retina and retinal pigment epithelium. Eye (Lond) 2020; 34:1973-1988. [PMID: 32367006 PMCID: PMC7784997 DOI: 10.1038/s41433-020-0902-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/12/2020] [Accepted: 03/17/2020] [Indexed: 11/09/2022] Open
Abstract
This paper reviews the published literature on a group of developmental disorders of the retina and retinal pigment epithelium which result in focal abnormalities in one or both eyes. They are often asymptomatic, found on routine examination and are generally non-progressive. Some are associated with other systemic abnormalities.
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Affiliation(s)
- Yingna Liu
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Anthony T Moore
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA.
- University College London Institute of Ophthalmology, London, UK.
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Nassar S, Tarbett AK, Browning DJ. Choroidal Cavitary Disorders. Clin Ophthalmol 2020; 14:2609-2623. [PMID: 32982154 PMCID: PMC7490088 DOI: 10.2147/opth.s264731] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/07/2020] [Indexed: 11/23/2022] Open
Abstract
The structure and functions of the choroid have been long acknowledged but the pathophysiology behind various anomalies has been difficult to understand until the advent of optical coherence tomography (OCT). With OCT imaging, choroidal cavitations appear as optically empty spaces between the outer retinal and choroidal layers with attenuation or loss of outer retinal layers. Choroidal cavitations are found in the posterior pole and seen in conditions such as pathologic myopia, north carolina macular dystrophy (NCMD), focal choroidal excavation (FCE), and torpedo maculopathy (TM). To date, these disorders have not been linked. A commonality they all share is malformation of the RPE-photoreceptor-choroid complex. The following report describes the differences and similarities of choroidal cavitation amongst the different retinal disorders and emphasizes the importance of multimodal imaging in the detection and management of potential complications.
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Affiliation(s)
- Sandra Nassar
- Eye Department, Charlotte Eye, Ear, Nose, and Throat Associates, Charlotte, NC 28210, USA
| | - Aaron K Tarbett
- Eye Department, WG Hefner VA Medical System, Salisbury, NC 28144, USA
| | - David J Browning
- Eye Department, Charlotte Eye, Ear, Nose, and Throat Associates, Charlotte, NC 28210, USA
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15
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Badawi AH, Magliyah M, Allam K, Alzahrani YA. Foveal Congenital Simple Hamartoma of Retinal Pigment Epithelium: A Report of Two Cases. Middle East Afr J Ophthalmol 2020; 27:128-130. [PMID: 32874047 PMCID: PMC7442079 DOI: 10.4103/meajo.meajo_177_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/26/2020] [Accepted: 06/06/2020] [Indexed: 12/02/2022] Open
Abstract
We report two cases with foveal congenital simple hamartoma of the retinal pigment epithelium (CSHRPE), as both patients presented to our retina services complaining of a unilateral decreased vision. Full ophthalmic examination and multimodal imaging were performed including fundus photography, fundus autofluorescence, optical coherence tomography, fluorescein angiography, and electrophysiological testing. Both patients presented with 20/80 vision in the affected eyes. Foveal CSHRPE was found in both eyes, along with parapapillary hyperpigmented rim, multiple pinpoint macular lesions, and few posterior pole hyperpigmented lesions. Multifocal electroretinogram showed diminished central amplitude in both eyes, with three-dimensional topography map showing blunted foveal peaks in one eye and the absence of a central peak in the other patient. Both patients had a stable vision and clinical examination of the CSHRPE during 5 and 6 years follow up, respectively. Foveal CSHRPE is usually symptomatic and results in a decline in visual acuity. Follow-up of these patients showed stable vision and clinical examination.
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Affiliation(s)
- Abdulrahman H Badawi
- Vitreoretinal Division, King Khalid Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Moustafa Magliyah
- Vitreoretinal Division, King Khalid Eye Specialist Hospital, Riyadh, Saudi Arabia.,Department of Ophthalmology, Prince Mohammed Medical City, AlJouf, Saudi Arabia
| | - Khalid Allam
- Department of Ophthalmology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Yahya A Alzahrani
- Ophthalmology Department, King Fahad Medical City, Riyadh, Saudi Arabia
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16
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Arjmand P, Elimimian EB, Say EAT, Shields CL. OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY OF CONGENITAL SIMPLE HAMARTOMA OF THE RETINAL PIGMENT EPITHELIUM. Retin Cases Brief Rep 2020; 13:357-360. [PMID: 28489706 DOI: 10.1097/icb.0000000000000596] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the optical coherence tomography angiography features of congenital simple hamartoma of the retinal pigment epithelium. METHODS Case report. RESULTS A 14-year-old boy was referred for an asymptomatic fundus tumor in the left eye. Visual acuity was 20/20 in the right eye and 20/40 in the left eye. The right fundus was normal. The left fundus disclosed a gray-white nodular retinal mass of 2-mm diameter in the juxtafoveal region, protruding into the vitreous cavity and causing radial retinal folds. The mass demonstrated echodensity without calcification on ultrasonography, hypoautofluorescence on short-wavelength autofluorescence, and mixed hyporeflective and hyperreflective areas on near-infrared reflectance imaging. By fluorescein angiography, the mass showed absolute hypofluorescence through the arteriovenous phase and diffuse late hyperfluorescence and staining. Optical coherence tomography revealed an optically dense lesion with abrupt posterior shadowing, whereas optical coherence tomography angiography showed an extensive haphazard intratumoral vascular network with fairly large-caliber (100-200 microns) vessels occupying full-thickness tumor, demonstrating more vascular details than visualized on fluorescein angiography. Serial segmental evaluation of the optical coherence tomography angiography en face images confirmed an intratumoral vascular network for full tumor depth down to retinal pigment epithelium, not related to projection artifact. Final diagnosis was congenital simple hamartoma of the retinal pigment epithelium. Considering the benign tumor, observation was recommended. CONCLUSION Optical coherence tomography angiography of congenital simple hamartoma of the retinal pigment epithelium revealed an extensive intratumoral, haphazard, large-caliber vascular network, more evident than seen on fluorescein angiography. Optical coherence tomography angiography has added new insight into this rare tumor.
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Affiliation(s)
- Parnian Arjmand
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
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17
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Kerwat D, Jamall O, Antonakis S, Almeida GC. Torpedo maculopathy: A case series - insights into basic pathology. Eur J Ophthalmol 2020; 31:NP35-NP39. [PMID: 32037872 DOI: 10.1177/1120672120905313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
| | | | - Serafeim Antonakis
- Maidstone Hospital, Kent, UK.,Guy's and St Thomas' NHS Foundation Trust, London, UK
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18
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Wang H, Ly A, Yapp M, Assaad N, Kalloniatis M. Multimodal imaging characteristics of congenital grouped hyper- and hypo-pigmented fundus lesions. Clin Exp Optom 2019; 103:641-647. [PMID: 31769080 DOI: 10.1111/cxo.12984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/25/2019] [Accepted: 09/10/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The imaging characteristics of congenital grouped pigmentation of the retinal pigment epithelium (CGP-RPE) and its non-pigmented variant - grouped congenital albinotic retinal pigment epithelial spots (GCARPES) are poorly defined in the literature. Our case series reports their multimodal imaging characteristics across a spectrum of presentations. METHODS A retrospective review of patient records was conducted on patients seen at the Centre for Eye Health between January and December 2016. The multimodal imaging findings across four cases is described using optical coherence tomography (OCT), infrared imaging, ultra-widefield imaging, fundus photography and fundus autofluorescence (FAF). RESULTS Case 1 is a 55-year-old female with a bilateral presentation of CGP-RPE showing typical features. Case 2 is a 28-year-old male with a classical presentation of GCARPES in the left eye. Case 3 is a 33-year-old female with unilateral CGP-RPE and an atypical solitary congenital hypertrophy of the retinal pigment epithelium (CHRPE) in the same eye. Case 4 is a unilateral presentation in an 11-year-old female with unusual characteristics. Ocular imaging characteristics of CGP-RPE lesions varied between patients: OCT showed visible RPE changes in cases 3 and 4 but not case 1. The pattern of FAF and infrared imaging also varied with most lesions displaying a pattern of hypo-autofluorescence, but some central lesions in case 3 exhibited hyper-autofluorescence. All lesions were visible with fundus photography. CONCLUSION FAF can be helpful in alerting clinicians to the presence of lesions that may be difficult to visualise funduscopically and OCT can be helpful in differentiating between CGP-RPE and its variants from more sinister ocular conditions. All in all, these findings highlight the variable manifestation of CGP-RPE and its variants on multimodal imaging; the diagnosis of CGP-RPE and its variants should remain based on its characteristic funduscopic appearance.
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Affiliation(s)
- Henrietta Wang
- Centre for Eye Health, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Angelica Ly
- Centre for Eye Health, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Michael Yapp
- Centre for Eye Health, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Nagi Assaad
- Centre for Eye Health, Sydney, Australia.,Department of Ophthalmology, Prince of Wales Hospital, Sydney, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
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Bacquet JL, Uzzan J, Souied E. Une lésion pigmentée fovéolaire rare. J Fr Ophtalmol 2019; 42:e379-e380. [DOI: 10.1016/j.jfo.2019.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 02/13/2019] [Accepted: 03/05/2019] [Indexed: 11/28/2022]
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20
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Shanmugam PM, Konana VK, Ramanjulu R, Mishra KCD, Sagar P, Simakurthy S. Ocular coherence tomography angiography features of congenital hypertrophy of retinal pigment epithelium. Indian J Ophthalmol 2019; 67:563-566. [PMID: 30900602 PMCID: PMC6446643 DOI: 10.4103/ijo.ijo_801_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 12/11/2018] [Indexed: 11/04/2022] Open
Abstract
Congenital hypertrophy of retinal pigment epithelium (CHRPE) is a benign, pigmented, flat lesion arising from the retinal pigment epithelium (RPE). In this study, we describe optical coherence tomography angiography (OCTA) features of two eyes with solitary CHRPE. We found that the retinal vasculature over CHRPE was normal in both cases. We observed that in solitary CHRPE, segmentation artifacts can interfere in the interpretation of retinal vasculature due to thinning of the outer retina. Visualization of the underlying choroidal vasculature was obscured to some extent by masking effect of the hyperpigmented RPE. The choroidal vasculature was better appreciated on en face OCTA. On OCTA, the retinal and choroidal vasculature associated with CHRPE was found to be normal in our study.
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Affiliation(s)
- P Mahesh Shanmugam
- Department of Vitreoretina and Ocular Oncology, Sankara Eye Hospital, Bangalore, Karnataka, India
| | - Vinaya Kumar Konana
- Department of Vitreoretina and Ocular Oncology, Sankara Eye Hospital, Bangalore, Karnataka, India
| | - Rajesh Ramanjulu
- Department of Vitreoretina and Ocular Oncology, Sankara Eye Hospital, Bangalore, Karnataka, India
| | - K C Divyansh Mishra
- Department of Vitreoretina and Ocular Oncology, Sankara Eye Hospital, Bangalore, Karnataka, India
| | - Pradeep Sagar
- Department of Vitreoretina and Ocular Oncology, Sankara Eye Hospital, Bangalore, Karnataka, India
| | - Sriram Simakurthy
- Department of Vitreoretina and Ocular Oncology, Sankara Eye Hospital, Bangalore, Karnataka, India
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Rodrigues MW, Cavallini DB, Dalloul C, Shields CL, Jorge R. Retinal sensitivity and photoreceptor arrangement changes secondary to congenital simple hamartoma of retinal pigment epithelium. Int J Retina Vitreous 2019; 5:5. [PMID: 30675383 PMCID: PMC6332618 DOI: 10.1186/s40942-018-0154-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/31/2018] [Indexed: 12/05/2022] Open
Abstract
Background The congenital simple hamartoma of the retinal pigment epithelium is a benign lesion and previous observations with noninvasive imaging have detected potential photoreceptor abnormalities and retinal function interplay. Case presentation A 35-year-old woman was found to have an asymptomatic, solitary, circumscribed, pigmented lesion in her left eye. The patient underwent ophthalmic examination including multimodal evaluation with fluorescein angiography, near-infrared reflectance scanning laser ophthalmoscopy, blue autofluorescence, enhanced-depth imaging spectralis B-scan optical coherence tomography (EDI-SBOCT), en face OCT angiography (OCT-A) and microperimetry plus adaptive optics imaging. Ophthalmoscopic examination revealed a juxtafoveolar pigmented lesion with feeding retinal arteriole, consistent with congenital simple hamartoma of RPE. There was no macular edema, exudation, hemorrhage, traction or subretinal fluid. Multimodal imaging of the mass using fluorescein angiography revealed intra-lesion late staining, near-infrared reflectance imaging demonstrated intrinsic hyperreflectivity, short-wavelength autofluorescence and red-free filter photography revealed blocked signal, and SBOCT showed abrupt shadowing. On OCT-A, an exclusive ring-shaped vascular circuit with increased foveal avascular zone was noted. Adaptive optics revealed cell density arrangement and retinal sensitivity correlations on microperimetry. Conclusion These findings suggest that this hamartomatous lesion might cause specific cellular changes that impact retinal sensitivity response and potentially result from vasculature malnourishment to the outer retinal layers.
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Affiliation(s)
- M W Rodrigues
- 1Department of Ophthalmology, Ribeirão Preto School of Medicine, University of São Paulo, 3900, Bandeirantes Avenue, Ribeirão Prêto, SP 14049-900 Brazil
| | - D B Cavallini
- Department of Ophthalmology, São José do Rio Preto School of Medicine, São José do Rio Preto, Brazil
| | - C Dalloul
- Department of Ophthalmology, D'Olhos, São José do Rio Preto, Brazil
| | - C L Shields
- 4Ocular Oncology Service, Wills Eye Hospital, Philadelphia, USA
| | - R Jorge
- 1Department of Ophthalmology, Ribeirão Preto School of Medicine, University of São Paulo, 3900, Bandeirantes Avenue, Ribeirão Prêto, SP 14049-900 Brazil
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Pujari A, Temkar S, Agarwal S, Garg G, Chawla R, Kumar A. Foveolar simple retinal pigment epithelial hamartoma. Indian J Ophthalmol 2018; 66:999-1000. [PMID: 29941750 PMCID: PMC6032753 DOI: 10.4103/ijo.ijo_54_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Amar Pujari
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Shreyas Temkar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sahil Agarwal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Gaurav Garg
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohan Chawla
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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White EC, Sengillo JD, Cho GY, Bakhoum MF, Tsang SH. Congenital grouped albinotic spots of the retinal pigment epithelium in a patient with hemihypertrophy and café au lait spots. Doc Ophthalmol 2018; 137:9-14. [DOI: 10.1007/s10633-018-9639-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 05/09/2018] [Indexed: 11/30/2022]
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Ito Y, Ohji M. Long-Term Follow-Up of Congenital Simple Hamartoma of the Retinal Pigment Epithelium: A Case Report. Case Rep Ophthalmol 2018; 9:215-220. [PMID: 29681839 PMCID: PMC5903099 DOI: 10.1159/000487631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 02/12/2018] [Indexed: 12/04/2022] Open
Abstract
Background Congenital simple hamartoma of the retinal pigment epithelium (CSHRPE) is a rare benign tumor of the retinal pigment epithelium characterized by a focal, darkly pigmented nodule in the macular lesion in healthy persons. We report a case of CSHRPE with long-term follow-up. Case A 41-year-old Japanese woman was incidentally discovered to have a dark lesion on the fundus of the left eye. We evaluated the patient by measuring her best-corrected visual acuity (BCVA) and by slit-lamp biomicroscopy, fundus color photography, and optical coherence tomography (OCT) over a 10-year period. The BCVA gradually declined during the early follow-up period, having decreased from 1.2 to 0.8 in the left eye 3 years after the initial examination, and then has been maintained for the following 7 years. The lesion did not show a change in OCT 10 years after the first examination. Conclusion It is important to follow a CSHRPE carefully over the long term because visual acuity might decrease.
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Affiliation(s)
- Yuka Ito
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan
| | - Masahito Ohji
- Department of Ophthalmology, Shiga University of Medical Science, Otsu, Japan
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Baskaran P, Shukla D, Shah P. Optical coherence tomography and fundus autofluorescence findings in presumed congenital simple retinal pigment epithelium hamartoma. GMS OPHTHALMOLOGY CASES 2017; 7:Doc27. [PMID: 29082122 PMCID: PMC5655978 DOI: 10.3205/oc000078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Aim: Presumed congenital simple retinal pigment epithelium hamartoma is a rare benign lesion of the macula that mimics congenital hypertrophy of the retinal pigment epithelium (RPE) and combined hamartoma of the retina and the RPE; newer imaging modalities can help in diagnosis. We report three patients with presumed congenital simple RPE hamartoma, and describe the enhanced-depth imaging optical coherence tomography (EDI-OCT) and fundus autofluorescence (FAF) findings. Methods: Two patients were asymptomatic; one had an intraocular foreign body in addition to the hamartoma. All had a similar jet black, elevated lesion in the macula, sparing the fovea. EDI-OCT showed a characteristic hyperreflective layer with complete optical shadowing of the deeper layers; FAF showed pronounced hypoautofluorescence of the lesion. Conclusion: Multimodal imaging with FAF and EDI-OCT can help to differentiate simple RPE hamartoma from similar RPE lesions, and may serve as a useful adjunct to clinical diagnosis of this rare tumor. We present the second largest series of presumed congenital simple RPE hamartoma, and – to the best of our knowledge – the first report of FAF findings of this tumor.
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Affiliation(s)
- Prabu Baskaran
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | | | - Parag Shah
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, India
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Stavrakas P, Vachtsevanos A, Karakosta E, Kozeis N, Triantafylla M, Tranos P. Full-thickness macular hole associated with congenital simple hamartoma of retinal pigment epithelium (CSHRPE). Int Ophthalmol 2017; 38:2179-2182. [PMID: 28828540 DOI: 10.1007/s10792-017-0676-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/01/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE To report a unique case of congenital simple hamartoma of retinal pigment epithelium (CSHRPE) associated with full-thickness macular hole (FTMH). METHODS A 14-year-old female with a previous diagnosis of simple hamartoma of retinal pigment epithelium in the left eye presented with a 3-week onset of reduced visual acuity in the same eye. Complete ophthalmological examination with spectral domain ocular coherence tomography (SD-OCT) and autofluorescence imaging was carried out. Results were compared with the last 4-year follow-up data. RESULTS On examination, visual acuity in the left eye was counting fingers compared to 20/100 documented in the last follow-up. Fundoscopy revealed a nodular, heavily pigmented, circumscribed foveal mass, with 0.5 mm basal diameter and 1.1 mm thickness corresponding to the simple RPE hamartoma. Although the latter remained unchanged throughout the follow-up period, a new lesion at the inferior edge of the hamartoma was noted. SD-OCT confirmed the presence of a FTMH with no evidence of associated epiretinal membrane, vitreomacular traction or posterior vitreous detachment. After explaining the risks and benefits of vitrectomy for FTMH, the patient declined surgery. CONCLUSIONS CSHRPE may have associated features such as feeding vessels, retinal surface wrinkling, pigmented vitreous cells, retinal exudation and vitreoretinal adhesion. The case presented herein broadens the clinical spectrum of CSHRPE and emphasizes that despite the benign nature of the lesion, which remains stable without growth, visual loss may occur, attributable to foveal traction and development of FTMH. We postulate that protrusion of the tumor into the vitreous cavity results in tissue stretching and development of anteroposterior and tangential forces which may lead to development of macular hole.
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Affiliation(s)
- Panagiotis Stavrakas
- 2nd Department of Ophthalmology, National and Kapodistrian University Athens Medical School, "Attikon" University General Hospitals, 1 Rimini Street, Chaidari, 12243, Athens, Greece.
| | | | - Efthymia Karakosta
- "Ophthalmica" Institute of Ophthalmology, 196 Vas. Olgas Road, 54655, Thessaloniki, Greece
| | - Nikos Kozeis
- "Ophthalmica" Institute of Ophthalmology, 196 Vas. Olgas Road, 54655, Thessaloniki, Greece
| | - Magdalini Triantafylla
- "Ophthalmica" Institute of Ophthalmology, 196 Vas. Olgas Road, 54655, Thessaloniki, Greece
| | - Paraschos Tranos
- "Ophthalmica" Institute of Ophthalmology, 196 Vas. Olgas Road, 54655, Thessaloniki, Greece
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Matos R, Gil P, Monteiro S, Cortesão D. A Pigmented Lesion in an Umbrella Fashion. J Pediatr Ophthalmol Strabismus 2017; 54:192. [PMID: 28537644 DOI: 10.3928/01913913-20170313-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 06/08/2016] [Indexed: 11/20/2022]
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28
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Shields JA, Shields CL. Tumors and Related Lesions of the Pigmented Epithelium. Asia Pac J Ophthalmol (Phila) 2017; 6:215-223. [PMID: 28399346 DOI: 10.22608/apo.201705] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 02/06/2017] [Indexed: 11/08/2022] Open
Abstract
Several tumors and pseudotumors can arise from the iris pigment epithelium (IPE), ciliary pigment epithelium (CPE), and retinal pigment epithelium (RPE), including cysts of the IPE, solitary congenital hypertrophy of the RPE (CHRPE), multifocal CHRPE ("bear tracks"), congenital simple hamartoma of the RPE, combined hamartoma of the retina and RPE, and acquired epithelioma of IPE, CPE, and RPE. This article describes examples of pigment epithelial tumors and pseudotumors by reviewing the literature and cases on file in the Oncology Service at Wills Eye Hospital. Solitary CHRPE, traditionally believed to be stationary, can show growth in diameter in 83% and can spawn elevated nodular tumors that can progressively enlarge, cause complications, and even evolve into malignant epithelioma (adenocarcinoma). Multifocal CHRPE (congenital grouped pigmentation) has no relationship to familial adenomatous polyposis or Gardner syndrome, despite its similarity to the pigmented fundus lesions seen with those conditions. Congenital simple hamartoma of the RPE is a specific lesion that involves the fovea and does not tend to cause complications. Combined hamartoma, an idiopathic proliferation of RPE cells, blood vessels, and glial cells, is also believed to be a relatively stable lesion but can cause vision loss due to traction. Acquired tumors (adenoma, adenocarcinoma) have features distinct from melanoma clinically and histopathologically. Torpedo maculopathy is a small stable lesion with typical features, resembling a torpedo. There are several intriguing tumors and pseudotumors of the pigmented epithelium that have major clinical and histopathologic importance.
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Affiliation(s)
- Jerry A Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
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Abstract
: The primary eye care practitioner assumes an important role in clinical decisions involving the differentiation between malignant and nonmalignant pigmented lesions. A misdiagnosis may have profound consequences on patient management and visual or life prognosis. However, information on these lesions, particularly their appearance using advanced imaging, is fragmented throughout the literature. The purpose of this review is to describe these features in detail, so that the implications of this information on clinical practice are more readily apparent. Clinically relevant descriptions of pigmented lesions of the retinal pigment epithelium using traditional and advanced imaging modalities in the literature were collated and integrated with findings from patients seen at the Centre for Eye Health. The information was then organized and tabulated. Finally, a flow diagram was created to be used as a clinical reference in the differential diagnosis of pigmented lesions of the retinal pigment epithelium.
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Abstract
PURPOSE Presumed congenital simple hamartoma of the retinal pigment epithelium (CSHRPE) is a rare intraocular finding that is described as a focal, nodular, jet black lesion. These lesions frequently occur at or near the macula and have no known association with changes in the surrounding neurosensory retina, retinal pigment epithelium, or choroid, nor have they been related with exudation or hemorrhage. Until now, there have been no cases reported of CSHRPE with associated vascular activity. CASE REPORT A 14-year-old Hispanic adolescent girl with a presumed CSHRPE presented with adjacent macular edema. The patient was treated with an off-label intravitreal bevacizumab injection to decrease the edema. Two months later, the patient presented with improved visual acuity and decreased macular edema. CONCLUSIONS This is the first documented case of macular edema secondary to vascular activity being associated with these rare lesions. When CSHRPE is found to have secondary vascular activity and associated macula edema, treatment of intravitreal bevacizumab may lead to improved visual and anatomical outcomes.
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31
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High-penetration optical coherence tomography and enhanced depth imaging in presumed retinal pigment epithelial hamartoma. Retin Cases Brief Rep 2015; 7:179-82. [PMID: 25391100 DOI: 10.1097/icb.0b013e31827aee75] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report on high-penetrating swept source optical coherence tomography (SS-OCT) imaging and enhanced depth imaging in an eye with presumed retinal pigment epithelial hamartoma . METHODS AND PATIENTS A 60-year-old man with presumed retinal pigment epithelial hamartoma underwent complete ophthalmologic examination, including fluorescein angiography, indocyanine green angiography, enhanced depth imaging OCT, and SS-OCT. RESULTS In the left eye, there were six darkly pigmented, nodular, circumscribed lesions in the macular area. The margins were well defined and were not associated with changes such as edema, exudation, or hemorrhage. Fluorescein angiography revealed a minimally dilated feeding artery and draining vein in each lesion. Spectral domain OCT demonstrated an elevation of the retina at the site of the lesions with greatly enhanced optical reflectivity of the inner surface and complete shadowing of optical transmission with crisp vertical margins. However, enhanced depth imaging OCT and SS-OCT revealed deeper retinal layer structures in the pigmented lesions. Intraretinal lesions showed superficial involvement and preretinal extension with or without superficial hyporeflective regions. CONCLUSION Enhanced depth imaging OCT and SS-OCT revealed deeper retinal layer structures in the pigmented lesions in a case with presumed retinal pigment epithelial hamartoma. Enhanced depth imaging OCT and SS-OCT are useful for visualization of intraretinal structures in these lesions, leading to further investigation of the origin and development of retinal pigment epithelial hamartoma.
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Congenital simple hamartoma of the retinal pigment epithelium with a full-thickness macular hole. Retin Cases Brief Rep 2014; 3:80-2. [PMID: 25390848 DOI: 10.1097/icb.0b013e318158de64] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Congenital simple hamartoma of the retinal pigment epithelium (CSHRPE) is a rare tumor that, to our knowledge, has not been previously reported as being associated with a full-thickness macular hole. METHODS We report a case of a CSHRPE associated with a full-thickness macular hole. Findings of funduscopy and optical coherence tomography are described. RESULTS A 10-year-old boy presented with visual acuity of 20/80 in the right eye. Funduscopy revealed a juxtafoveal pedunculated, well-circumscribed, darkly pigmented lesion measuring one third of a disk diameter. There was an associated full-thickness macular hole that separated the main dark mass nasally from a linear pigmented lesion. Optical coherence tomography showed a mass with optical shadowing and confirmed the presence of a full-thickness macular hole surrounded by intraretinal cystic edema. No evidence of a posterior vitreous detachment or significant epiretinal membrane was seen. CONCLUSION We observed a full-thickness macular hole with a CSHRPE in a 10-year-old boy. The CSHRPE may have induced tangential traction along the posterior hyaloid or abnormal anteroposterior traction with foveal dehiscence. It is possible that exudation from the lesion into the vitreous cavity may result in vitreous changes with premature liquefaction and degenerative alterations that may induce abnormal vitreous adhesion and traction. Optical coherence tomography did not show evidence of such changes.
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Wong EN, Fraser-Bell S, Hunyor AP, Chen FK. Novel optical coherence tomography classification of torpedo maculopathy. Clin Exp Ophthalmol 2014; 43:342-8. [DOI: 10.1111/ceo.12435] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 09/07/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Evan N Wong
- Centre for Ophthalmology and Visual Science (Incorporating the Lions Eye Institute); The University of Western Australia; Perth Western Australia
| | - Samantha Fraser-Bell
- Discipline of Clinical Ophthalmology and Eye Health; University of Sydney; Sydney New South Wales Australia
- Chatswood Retina Service; Retina Associates; Sydney New South Wales Australia
| | - Alex P Hunyor
- Chatswood Retina Service; Retina Associates; Sydney New South Wales Australia
- Australian School of Advanced Medicine; Macquarie University; Sydney New South Wales Australia
| | - Fred K Chen
- Centre for Ophthalmology and Visual Science (Incorporating the Lions Eye Institute); The University of Western Australia; Perth Western Australia
- Department of Ophthalmology; Royal Perth Hospital; Perth Western Australia Australia
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Villegas VM, Schwartz SG, Flynn HW, Capó H, Berrocal AM, Murray TG, Harbour JW. Distinguishing Torpedo Maculopathy From Similar Lesions of the Posterior Segment. Ophthalmic Surg Lasers Imaging Retina 2014; 45:222-6. [DOI: 10.3928/23258160-20140410-01] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 02/10/2014] [Indexed: 11/20/2022]
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Congenital simple hamartoma of the retinal pigment epithelium: clinical, optical coherence tomography, and histopathological correlation. Eye (Lond) 2014; 28:765-6. [PMID: 24603418 DOI: 10.1038/eye.2014.49] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Solitary congenital hypertrophy of the retinal pigment epithelium features by high-definition optical coherence tomography. Eur J Ophthalmol 2013; 24:566-9. [PMID: 24366775 DOI: 10.5301/ejo.5000420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe the features of solitary congenital hypertrophy of the retinal pigment epithelium (CHRPE) using high-definition optical coherence tomography (HD-OCT). METHODS This was a retrospective, observational, noncomparative case series including 16 consecutive patients with solitary CHRPE. We describe the clinical and OCT features of CHRPE using the 5 radial lines acquisition OCT protocol over the CHRPE and the retina next to the tumor. RESULTS The mean patient age was 54 years (median 57 years; range 8-76 years). The CHRPE lesion was outside the posterior pole in 14 of the patients (8 temporal, 3 superior, 2 nasal, and 1 inferior quadrant) and 2 peripapillary. Fifteen patients (94%) showed retinal thinning and complete photoreceptor loss overlying the CHRPE. The RPE hyperreflectivity was found in all patients. The retina over the lesion measured a mean of 60.3% (range 41%-95%) of the thickness of the adjacent normal retina. CONCLUSIONS High-definition OCT showed retinal thinning, photoreceptor loss, and RPE hyperreflectivity in solitary CHRPE lesions.
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Bedar MS, Holz FG, Lischka T. [Hypopigmentation temporal to the macula. Case report: torpedo maculopathy]. Ophthalmologe 2013; 110:173-4. [PMID: 23239134 DOI: 10.1007/s00347-012-2705-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- M S Bedar
- Universitäts-Augenklinik Bonn, Ernst-Abbe Str. 2, 53127, Bonn, Deutschland.
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39
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Congenital simple hamartoma of retinal pigment epithelium: clinical and imaging findings. Case Rep Ophthalmol Med 2012; 2012:654502. [PMID: 22606499 PMCID: PMC3350163 DOI: 10.1155/2012/654502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 01/24/2012] [Indexed: 11/17/2022] Open
Abstract
Congenital simple hamartoma of retinal pigment epithelium (CSHRPE) is a rare, asymptomatic, and incidentally detected benign lesion. However, it is very important to do the differential diagnosis from other pigmented retinal lesions. Its clinical presentation and imaging findings are very helpful in doing this differentiation. This paper presents clinical and imaging findings of a 56-year-old woman with incidentally detected CSHRPE. The lesion was small, heavily pigmented, well circumscribed, and slightly elevated. Optical coherence tomography (OCT) scanning was diagnostic and showed an elevated retina at the site of the lesion, increased optical reflectivity on its inner surface, optical shadowing of deeper structures, and clearly cut tumor margins. Ocular ultrasonography, fluorescein angiography, and fundus autofluorescence imaging which is firstly described in this report did not show any characteristic finding.
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40
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Kim DY, Hwang JC, Moore AT, Bird AC, Tsang SH. Fundus autofluorescence and optical coherence tomography of congenital grouped albinotic spots. Retina 2010; 30:1217-22. [PMID: 20539258 PMCID: PMC2939199 DOI: 10.1097/iae.0b013e3181cea5a5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to describe the findings of fundus autofluores-cence (FAF) and optical coherence tomography in a series of patients with congenital grouped albinotic spots. METHODS Three eyes of three patients with congenital grouped albinotic spots were evaluated with FAF and optical coherence tomography imaging to evaluate the nature of the albinotic spots. RESULTS In all three eyes with congenital grouped albinotic spots, FAF imaging showed autofluorescent spots corresponding to the albinotic spots seen on stereo biomicroscopy. One eye also had additional spots detected on FAF imaging that were not visible on stereo biomicroscopy or color fundus photographs. Fundus autofluorescence imaging of the spots showed decreased general autofluorescence and decreased peripheral autofluorescence surrounding central areas of retained or increased autofluorescence. Optical coherence tomography showed a disruption in signal from the hyperreflective layer corresponding to the inner and outer segment junction and increased signal backscattering from the choroid in the area of the spots. Fluorescein angiography showed early and stable hyperfluorescence of the spots without leakage. CONCLUSION In this case series, FAF showed decreased autofluorescence of the spots consistent with focal retinal pigment epithelium atrophy or abnormal material blocking normal autofluorescence and areas of increased autofluorescence suggesting retinal pigment epithelium dysfunction. The findings of optical coherence tomography and fluorescein angiography suggest photoreceptor and retinal pigment epithelium layer abnormalities. Fundus autofluorescence and optical coherence tomography are useful noninvasive diagnostic adjuncts that can aid in the diagnosis of congenital grouped albinotic spots, help determine extent of disease, and contribute to our understanding of its pathophysiology.
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Affiliation(s)
- David Y. Kim
- Bernard and Shirlee Brown Glaucoma Laboratory, Department of Ophthalmology, Columbia University College of Physicians and Surgeons, New York, New York
| | - John C. Hwang
- Bernard and Shirlee Brown Glaucoma Laboratory, Department of Ophthalmology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Anthony T. Moore
- Medical Retina Service, Moorfields Eye Hospital, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
| | - Alan C. Bird
- Medical Retina Service, Moorfields Eye Hospital, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
| | - Stephen H. Tsang
- Bernard and Shirlee Brown Glaucoma Laboratory, Department of Ophthalmology, Columbia University College of Physicians and Surgeons, New York, New York
- Department of Pathology & Cell Biology, Columbia University College of Physicians and Surgeons, New York, New York
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Su Y, Gurwood AS. Neurosensory retinal detachment secondary to torpedo maculopathy. ACTA ACUST UNITED AC 2010; 81:405-7. [DOI: 10.1016/j.optm.2010.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
PURPOSE Recent reports of torpedo maculopathy have disclosed underlying irregularities within the chorioretinal tissue that have not been shown to induce disturbances in visual function. Optical coherence tomography (OCT) provides a unique means of assessing the chorioretinal organization and integrity of torpedo lesions in an in vivo setting that has yet to be explored. In agreement with reported cases, torpedo maculopathy appears to be a benign, non-progressive condition that subtends the horizontal raphe in the juxtafoveal region and imparts no disturbance in visual function. CASE REPORTS Three cases of torpedo maculopathy were examined using Stratus OCT3 imaging (Carl Zeiss Meditec, Dublin, CA). OCT scans revealed intact, attenuated retinal layers with hyper-reflectivity of the retinal pigmented epithelium (RPE). The RPE subtending these lesions appears of normal thickness, yet, there is an abrupt transition between intact-organized and intact-disorganized retinal tissue in scans transitioning from normal retina to torpedo lesions. Our imaging studies revealed significant attenuation and disorganization of the inner and outer retinal layers overlying a hyper-reflective RPE, which was of normal thickness and devoid of any structural defects. CONCLUSIONS An analysis of the OCT images collected suggests anomalies in retinal architecture. This finding implies that these lesions may represent atypical colobomas whereby retinal tissues are present but, perhaps, not fully developed. In light of these imaging studies, we propose that this uncommon condition may arise from deficits in cellular migration and/or organization.
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Madgula IM, Adatia FA, Sagoo MS, Wescott M. Simple hamartoma of the retinal pigment epithelium in a man of African descent. Can J Ophthalmol 2009; 44:e35-6. [PMID: 19610251 DOI: 10.3129/i09-115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Abstract
PURPOSE Congenital simple hamartoma of the retinal pigment epithelium (CSHRPE) is a rare fundus condition. Two cases of CSHRPE are reported. METHODS The clinical findings and biomicroscopy, fluorescein angiography, optical coherence tomography (OCT), and ultrasonography features differentiating this pigmented macular tumor from uveal melanoma or retinal pigment epithelium (RPE) anomalies and neoplasms are discussed. RESULTS Two patients were observed with a pigmented macular lesion. Sharply demarcated transretinal lesions were seen in the macula of both patients, arising from the RPE. The periphery of the lesion in Case 1 was flat and black; the central portion was elevated and fibrotic with a central vitreous strand. A narrow crescent of RPE atrophy was noted temporally. Optical coherence tomography of both lesions showed the typical findings of CSHRPE: high reflectivity, irregular surface, abrupt borders, and full-thickness retinal shadowing. The decision was made to observe the lesions. During follow-up, the lesions remained unchanged. CONCLUSION The unusual finding of CSHRPE associated with RPE atrophy makes the differentiation between CSHRPE and hyperplasia of the RPE even more difficult. Noninvasive OCT has a major role in the diagnosis of CSHRPE.
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Bilateral congenital hamartomas of the retinal pigment epithelium in a patient with Down's syndrome. Eye (Lond) 2008; 22:735-6. [DOI: 10.1038/eye.2008.27] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Congenital simple hamartoma of the retinal pigment epithelium in an Asian. Jpn J Ophthalmol 2008; 52:144-145. [DOI: 10.1007/s10384-008-0509-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Accepted: 01/11/2008] [Indexed: 10/22/2022]
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López JM, Guerrero P. Congenital simple hamartoma of the retinal pigment epithelium: optical coherence tomography and angiography features. Retina 2006; 26:704-6. [PMID: 16829820 DOI: 10.1097/01.iae.0000236504.35268.96] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- José M López
- Department of Ophthalmology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
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CONGENITAL SIMPLE HAMARTOMA OF THE RETINAL PIGMENT EPITHELIUM: OPTICAL COHERENCE TOMOGRAPHY AND ANGIOGRAPHY FEATURES. Retina 2006. [DOI: 10.1097/00006982-200607000-00023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Karacorlu SA, Karacorlu M, Ozdemir H, Sanisoglu H. Indocyanine green angiographic findings in congenital grouped albinotic spots. Retina 2006; 26:470-2. [PMID: 16603969 DOI: 10.1097/01.iae.0000238539.36509.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Serra Arf Karacorlu
- Istanbul Retina Institute Inc., Hakki Yeten Cad. No. 87, 34349 Sisli, Istanbul, Turkey.
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