Torpedo maculopathy: in-vivo histology using optical coherence tomography

CASE OF TORPEDO MACULOPATHY WITH TWO DISTINCT ZONES OF THE RETINAL PIGMENT EPITHELIUM

BACKGROUND/PURPOSE

To report a case of torpedo maculopathy with two distinct zones of the retinal pigment epithelium visualized on optical coherence tomography.

METHODS

Observational case report.

RESULTS

A 6-year-old female presented for a routine examination. Visual acuity was 20/20 bilaterally. Dilated fundus examination was normal in the right eye. Dilated fundus examination of the left eye showed a wedge-shaped area of hypopigmentation in the temporal macula. Optical coherence tomography macula of the left eye showed outer retinal cavitation with segmentation of the foveal retinal pigment epithelium into a superficial fluffy zone and a deeper hyperreflective zone.

CONCLUSION

This case helps contribute to the growing body of the torpedo maculopathy literature that may reveal different stages of the same disease evolving over time.

Congenital focal abnormalities of the retina and retinal pigment epithelium

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.

Distribution patterns of torpedo maculopathy: Further evidence of a congenital retinal nerve fiber layer-driven etiology

With fewer than 100 peer-reviewed cases reported in the world to date, the underlying etiology of torpedo maculopathy has remained elusive. In this literature review, we provide new evidence to better support, reject and unify claims regarding cause, diagnosis, and proper clinical management of this disease. We reviewed 44 case reports and case series, which included 77 patients (after exclusions). We additionally introduced 3 new cases from our clinical practice for a total of 80 cases. Ages at presentation ranged from 6 months old to 73 years old (mean: 24.2 years old). The nasal aspects of torpedo maculopathy lesions pointed toward the optic disc and localized to a kite-shaped region of the temporal macula, correlating with the anatomic junction of the superior arcuate, inferior arcuate, and papillomacular bundles of retinal nerve fiber layer distribution. No patterns were observed among the temporal aspects of the lesions. These findings support a congenital etiology of torpedo maculopathy and a possible influence of the retinal nerve fiber layer in the development of mature retinal pigment epithelium.

Multimodal imaging of torpedo-shaped fundus lesions: New insights

The purpose of this case series is to describe the varied presentation of Torpedo lesions of the fundus and multimodal imaging features in three eyes of three patients. Two patients presented with typical topography, i.e., temporal to the fovea. One patient revealed lesion inferonasal to disc with the head pointing toward the disc. All three patients had an attenuation of outer retinal layers on optical coherence tomography. One patient showed an additional large subretinal cleft. Variable hypoautofluorescence in the area of the torpedo was noted. To conclude torpedo lesions can present at atypical locations, have both retinal and choroidal atrophy and head point toward the optic disc.

MULTIMODALITY IMAGING OF TORPEDO MACULOPATHY WITH SWEPT-SOURCE, EN FACE OPTICAL COHERENCE TOMOGRAPHY AND OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY

PURPOSE

Multimodality image analysis of two cases of torpedo maculopathy.

METHODS

Imaging with fundus photography, autofluorescence (AF), swept-source optical coherence tomography (OCT), en face OCT, and OCT angiography.

RESULTS

The basal diameter of the torpedo lesions was 1 mm × 2 mm. One case had a satellite lesion. Autofluorescence indicated variable loss of signal. Swept-source OCT and en face OCT demonstrated fundus excavation, attenuation of nuclear layers and disruption of the outer plexiform layer, loss of photoreceptors and a subretinal cleft. In one case, Sattler layer appeared extended at the cleft. Optical coherence tomography angiography indicated loss of flow in deep retinal vessels and increased flow in choroidal vessels surrounding the cleft.

CONCLUSION

Multimodal imaging findings of torpedo maculopathy include disruption of the deep retinal capillary network, expansion of Sattler layer, and increased signal around the subretinal cleft.

Torpedo maculopathy with multifocal central serous chorioretinopathy: A rare case report

We present a very rare case of torpedo maculopathy (TM) with multifocal central serous chorioretinopathy. A 26-year-old male presented with painless loss of vision in the right eye of 2 months duration. Clinical examination showed a torpedo-shaped lesion temporal to fovea and subretinal fluid in foveal center. Fluorescein angiography showed multifocal leaks. Optical coherence tomography showed an optically clear space/neurosensory detachment at the site of lesion. Patient underwent focal laser to the leaks. TM is a rare congenital disorder detected accidentally during routine fundus examination. It is usually unilateral and does not affect vision.

Torpedo Maculopathy in a 6-Month-Old Infant: Early Clinical and Optical Coherence Tomography Findings

A 6-month-old male infant presented for routine ophthalmologic examination. Indirect ophthalmoscopy revealed a flat, oval, hypopigmented lesion located in the temporal macula in the right eye with the tip pointing toward the fovea, which was compatible with torpedo maculopathy. Optical coherence tomography (OCT) was performed at the time of diagnosis. OCT scans of the lesion revealed slight retinal pigment epithelium hyperreflectivity. This case serves as the earliest OCT finding of the youngest patient diagnosed as having torpedo maculopathy in the literature. [J Pediatr Ophthalmol Strabismus. 2017;54:e54-e57.].

Torpedo maculopathy: Two case reports and a literature review

CASE REPORTS

The cases concern a 4 year-old boy and 25 year-old female with 20/20 visual acuity, who presented with a unilateral non-pigmented macular lesion, temporal to the fovea, a torpedo shaped defect in the retinal pigment epithelium (RPE). Optical coherence tomography showed attenuation of the RPE signal, and in the second patient there proved to be a neurosensory detachment, RPE atrophy, and thinning of the retinal layers. The lesion was hypoautofluorescent and hyperfluorescent on fluorescein angiography.

DISCUSSION

Torpedo maculopathy is an asymptomatic characteristic lesion which should be considered in the differential diagnosis of macular lesions in children and young patients.

Spectral-domain optical coherence tomography and fundus autofluorescence evaluation of torpedo maculopathy

The authors describe the spectral-domain optical coherence tomography and fundus autofluorescence findings in a case of torpedo maculopathy. Spectral-domain optical coherence tomography revealed loss or disruption of the retinal pigment epithelium and overlying disruption of the outer neurosensory retina. Fundus autofluorescence revealed reduced fundus autofluorescence of the lesion surrounded by a rim of increased fundus autofluorescence.