Torpedo maculopathy complicated by choroidal neovascularization.

Case report

A 19-year-old woman presented with a two-week history of metamorphopsia in her left eye. She has been previously diagnosed with a “macular scar” in the left eye, which was consistent with a torpedo lesion in a previous fundus photograph (Fig. 1-A). Her past medical history was unremarkable.

Fig. 1

Fundus photograph of the left eye before (A) and after (B) development of CNV.

The right eye was completely normal on examination. The left eye had corrected visual acuity of 20/30 and intraocular pressure of 13 mmHg. There was no evidence of anterior chamber or vitreous inflammation. In the posterior segment exam of the left eye a creamy gray subretinal lesion was visible on the temporal border of the torpedo lesion (Fig. 1-B).

Optical coherence tomography (Spectralis®, Heidelberg, Germany) of the left eye (Fig. 2) revealed an irregular elevation of the retina on the temporal aspect of the fovea by non-homogenous hyperreflective subretinal material demonstrating disruption of the retinal pigment epithelium, interdigitation and ellipsoid zones and preservation of the external limiting membrane (ELM) consistent with a type 2 choroidal neovascularization (CNV.) There was small cleft of subretinal fluid on the foveal side of the lesion. Bruch's membrane underneath the lesion had an outwardly bowed configuration consistent with choroidal excavation. OCT angiography (Optovue®, Fremont, CA) confirmed the presence of a neovascular frond in outer retina, temporal to the fovea (Fig. 3). The patient was treated with an injection of intravitreal bevacizumab.

Fig. 2

Infrared image of the left macula shows the retinal pigment epithelial abnormality. SD-OCT shows non-homogenous subretinal hyper-reflective material, disruption of the ellipsoid and interdigitation zones, subretinal fluid (white arrow) and choroidal excavation.

Fig. 3

OCTA of the left eye: A neovascular frond is visible at the level of outer retinal and choriocapillaris slabs.

Discussion

Torpedo maculopathy is a rare, typically unilateral, congenital lesion signified by a torpedo-shaped patch of hypopigmentation temporal to the fovea. Vision is usually normal. OCT abnormalities are usually seen in the outer retina, sometimes with loss of photoreceptors in the area. Inner retinal layers are nearly normal in appearance at the site of torpedo lesion. Some cases of torpedo maculopathy have accompanying choroidal excavation. OCT angiography may reveal abnormalities of choriocapillaris subjacent to the lesion. A literature search revealed only two previous reports of torpedo retinopathy complicated by CNV., In the case reported by Jurjevic et al. there was a choroidal excavation in the temporal part of the lesion. OCT findings of the other case were not presented. Development of CNV has been reported in association with choroidal excavations. In the present case, development of CNV may be related to the presence of the focal choroidal excavation.

Conclusion

Torpedo maculopathy, an unusual congenital lesion may rarely be complicated by the development of CNV. In these cases, we recommend patient education regarding the symptoms of CNV and advise prompt retinal evaluation as treatment may be warranted.

Funding

NIH Core Grant P30 EY08098 to the Dept of Ophthalmology, from the , and from an unrestricted grant from , New York, NY and Pennsylvania Lions Club, Harrisburg.

Authorship

“All authors attest that they meet the current ICMJE criteria for Authorship".

Research ethics

Consent to publish the case report was not obtained. This report does not contain any personal information that could lead to the identification of the patient.

Declaration of competing interest

None.