Diabetic Retinopathy (DR) is the premier cause of blindness world over and is the leading ocular complication of diabetes. Visual morbidity in diabetic retinopathy is largely because of Diabetic Macular Edema (DME), although the tractional and hemorrhagic issues of proliferative diabetic retinopathy (PDR) are the more debilitating. There has been a paradigm shift in the gold standard of therapy from macular laser photocoagulation to the current era of anti-Vascular endothelial growth factor therapy (anti-VEGF). The three anti-VEGF injections in vogue are ranibizumab, bevacizumab and aflibercept. Several trials have provided critical information on their safety, efficacy and their dosage as well as dosing regimens. Steroid injections and depot formulations remain in the therapeutic armamentarium, despite their cataractogenic and intraocular pressure elevating side effects. The repetitive nature of the injections and the fact that there still remains a significant quanta of patients that are non-responsive or refractory in time to the anti-VEGF injections, has fuelled continued research for newer therapeutic alternatives.

We are reporting a case of torpedo maculopathy (TM) over a long term follow up with the aid of multimodal imaging of Optical coherence tomography (OCT), Fundus Autofluorescence, En Face OCT, and recent OCT angiography (OCTA) findings. An asymptomatic 18 years old female was clinically found to be having a whitish spindle shaped lesion in the right eye with classic findings of TM. OCT imaging at baseline and at 2 and 4 years follow up did not reveal any change in the retinal structures. A focal excavation of the choroid along with a small subretinal cleft was also seen. Fundus autofluorescence imaging exhibits a central hypofluorescence along with a hyperfluorescent border corresponding to the lesion. OCTA segmentation of the choriocapillaris vasculature showed increased density of the choroidal vasculature suggestive of its role in the pathogenesis of this lesion. Enigma behind the pathogenesis of this rare lesion is still unsolved. Recently introduced imaging techniques can help us understand this lesion and its pathogenesis in detail.

A 56-year-old male underwent cardiac balloon angioplasty for coronary artery stenosis and after 1 week presented with sudden painless diminution of vision in the left eye. On examination, the best-corrected visual acuity was 6/6, and hand movement was close to the face in right and left eye, respectively. The detailed evaluation revealed hemicentral retinal artery occlusion in the left eye, whereas the right was within normal limits. The patient was treated with anti-glaucoma medication and referred to a cardiologist for further evaluation and treatment. The patient underwent left internal carotid artery balloon angioplasty and stenting. At 2 weeks follow-up, reperfusion was noted in the left eye.

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