Abstract:This study is the first case series of torpedo maculopathy in the paediatric population. Contrary to previous reports of two distinct types of lesion on OCT representing different stages of the same disease, our case series indicates that Type 1 and Type 2 lesions are in fact different phenotypic entities both of which can occur at a young age. We also present the associated risk of choroidal neovascular membrane formation which is an important consideration for long term follow-up.
“…Although, patients with torpedo lesions are asymptomatic and experience a benign and nonprogressive disease course, the CNV membrane in TM has been described. [14,15] The presence of CNV can lead to disturbance in vision and deterioration in visual acuity. Patient 6 in our series developed CNV.…”
Purpose: Torpedo lesions in the retina are rare. This study aimed to investigate torpedoshaped lesions in the retina in an adult population and to determine the spectrum and features of the disease.
Methods: The review of a database for clinical diagnosis identified nine patients who were diagnosed with torpedo-shaped lesions in the retina between June 2017 and February 2019. Fundus photography and optical coherence tomography (OCT) imaging were used to analyze the cases. Multicolor imaging was also performed.
Results: Nine patients with torpedo-shaped lesions in the fundus were identified. Fundus images revealed that the lesion involved the macula in six eyes; in the remaining three eyes, the lesion was present outside the macula. OCT identified six patients with type 1 torpedo lesions, one with type 2, and two with type 3. On multicolor imaging, the lesion was visualized as a region of increased reflectance in blue, green, and infrared light in all eyes, with notably increased infrared reflectance in eyes with focal choroidal excavation. Choroidal neovascular membrane was evident in one patient on OCT angiography.
Conclusion: Torpedo lesions in the retina can occur away from the macula and exhibit features similar to those of torpedo maculopathy. As such, the authors propose a change in the nomenclature for torpedo lesions in the retina from “torpedo maculopathy” to “torpedo retinopathy.”
“…Although, patients with torpedo lesions are asymptomatic and experience a benign and nonprogressive disease course, the CNV membrane in TM has been described. [14,15] The presence of CNV can lead to disturbance in vision and deterioration in visual acuity. Patient 6 in our series developed CNV.…”
Purpose: Torpedo lesions in the retina are rare. This study aimed to investigate torpedoshaped lesions in the retina in an adult population and to determine the spectrum and features of the disease.
Methods: The review of a database for clinical diagnosis identified nine patients who were diagnosed with torpedo-shaped lesions in the retina between June 2017 and February 2019. Fundus photography and optical coherence tomography (OCT) imaging were used to analyze the cases. Multicolor imaging was also performed.
Results: Nine patients with torpedo-shaped lesions in the fundus were identified. Fundus images revealed that the lesion involved the macula in six eyes; in the remaining three eyes, the lesion was present outside the macula. OCT identified six patients with type 1 torpedo lesions, one with type 2, and two with type 3. On multicolor imaging, the lesion was visualized as a region of increased reflectance in blue, green, and infrared light in all eyes, with notably increased infrared reflectance in eyes with focal choroidal excavation. Choroidal neovascular membrane was evident in one patient on OCT angiography.
Conclusion: Torpedo lesions in the retina can occur away from the macula and exhibit features similar to those of torpedo maculopathy. As such, the authors propose a change in the nomenclature for torpedo lesions in the retina from “torpedo maculopathy” to “torpedo retinopathy.”
“…Fundus exam shows a hypopigmented, horizontally oriented, oval-shaped lesion in the temporal macula ( Figure 7 ). 91 , 92 Although typically unilateral, bilateral cases have been reported. 93 , 94 TM is non-progressive and spares the fovea.…”
Section: Torpedo Maculopathymentioning
confidence: 99%
“… 95 , 96 While usually isolated, occasionally small, round satellite lesions temporal to the main lesion have been noted. 88 , 92 , 97 , 98 Choroidal cavitation in TM differs from FCE in which lesions are not usually oval in shape, typically involve the fovea, and are associated with less outer retinal thinning and degeneration. 42 Figure 7 Color fundus photograph ( A ) near infrared reflectance image ( B ), and SD-OCT image ( C ) of an 8-year-old girl with torpedo maculopathy of the right eye.…”
Section: Torpedo Maculopathymentioning
confidence: 99%
“… 97 Wong et al hypothesized that the Type 1 subtype progressed to type 2 over time but reports of type 2 TM in patients as young as 5 years old cast doubt on that hypothesis. 92 …”
Section: Torpedo Maculopathymentioning
confidence: 99%
“…A developmental disruption is speculated to occur at some point during the last 3 months and the variation in the time of occurrence accounts for different clinical TM phenotypes. 92 , 101 …”
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.
ImportanceMost ocular lesions have been described for children with congenital Zika syndrome. The frequency of finding ocular abnormalities is unknown among children exposed to Zika virus (ZIKV) during pregnancy. This study was conducted on newborns whose mothers were positive for ZIKV, confirmed with reverse-transcription polymerase chain reaction (RT-PCR) testing.ObjectiveTo report ocular fundus manifestations in newborns with congenital ZIKV exposure in French Guiana, Martinique, and Guadeloupe, French West Indies, to assess its prevalence. Risk factors, such as the presence of extraocular fetopathies and the gestational term at infection, were sought.Design, Setting, and ParticipantsThis was a cross-sectional multicentric study, conducted from August 1, 2016, to April 30, 2019, for which data were collected prospectively. The study inception was at the beginning of 2016 from the onset of the ZIKV epidemic in the French West Indies. Newborns whose mothers tested positive (by RT-PCR) for ZIKV during pregnancy were included.InterventionsFundus examination was performed using widefield retinal imaging after pupil dilation. Infection date, delivery mode, and newborn measurements were collected.Main Outcomes and MeasuresAnomalies of the vitreous, choroid, retina, and optic disc.ResultsA total of 330 children (mean [SD] age, 68 [IQR, 22-440] days; 170 girls [51.5%]) were included. Eleven children (3.3%) had perivascular retinal hemorrhages, and 3 (0.9%) had lesions compatible with congenital ZIKV infection: 1 child had torpedo maculopathy, 1 child had a chorioretinal scar with iris and lens coloboma, and 1 child had a chorioretinal scar. Retinal hemorrhages were found at childbirth during early screening. Lesions compatible with congenital ZIKV infection were not associated with the presence of extraocular fetopathy. Microcephaly was not associated with lesions compatible with congenital ZIKV infection (odds ratio [OR], 9.1; 95% CI, 0.8-105.3; P = .08), but severe microcephaly was associated with an OR of 81 (95% CI, 5.1-1297.8; P = .002).Conclusions and RelevanceResults of this cross-sectional study suggest that the ocular anomalies found may be associated with ZIKV in 0.9% of the exposed population. Ocular lesions were rare, affected mostly the choroid and retina, and seemed to be associated with choroiditis-related scarring that developed during fetal growth.
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