Benign panretinal uniform radial linear‐shaped flecks

Abstract

Our case illustrates a new presentation of benign retina flecks with line-shaped and panretinal, uniform and radial distribution. Compared with previous reports of fleck retina disorders, our case does not show increased autofluorescence deposits, no delay in dark adaptation, neither significant macular nor nasal disc involvement. [1][2][3][4][5] A 51-year-old woman with consanguinous parents was referred for evaluation of bilateral retinal lesions. On examination, best-corrected visual acuity was 6/7.5 with moderate hyperopic correction in both eyes. Visual fields were normal. The anterior segments were unremarkable.Fundus examination revealed multiple yellow-creamy discrete round and mostly linear-shaped flecks scattered throughout the retina in both eyes with relative sparing of the fovea. The flecks distributed in a radial pattern centred around the posterior pole ( Fig. 1) and were located well posterior to the retinal vasculature. The discs, maculae and retinal vessels appeared unremarkable. Fundus autofluorescence imaging (cSLO, Heidelberg Retina Angiograph 2; Heidelberg Engineering, Dossenheim, Germany) did not show hyper-or hypofluorescent flecks (Fig. 2a), but multiple discrete round lesions above the retinal pigment epithelium were apparent in the infrared imaging (Fig. 2b). Corresponding spectral optical coherence tomography (Optivue SD-OCT, Fremont, CA, and Cirrus, Carl Zeiss Meditec Inc., Dublin, CA, USA) revealed that these lesions span across the retinal pigment epithelium complex and photoreceptor inner-outer segment junction layers, without involving the choroid (Figs 3,4). To assess retinal function, ISCEV (International Society for Clinical Electrophysiology of Vision) standardized full-field electroretinography were performed following 20 min and overnight dark adaptation. The electroretinography traces showed that both scotopic and photopic responses were symmetric and within normal limits (Fig. 5).In contrast to previous reports, 1-3 the retinal lesions in our patient appeared to be significantly smaller, more of a linear shape(s) and uniform in size(s). These lesions were distributed ubiquitously in the equator and mid and far periphery of the fundus. The centrally located flecks in the posterior pole appeared sparse, small, round and dot-like. Unfortunately, the patient's family members were not available for eye examination. In contrast to the classic findings reported by Audo et al.,4 where the retinal flecks demonstrated increased autofluorescence, the fundus imaging of our patient did not show any specks of abnormal autofluorescence. * These authors contributed equally to this report.Financial Disclosure: SHT is a fellow of the Burroughs-Wellcome