oc000265
10.3205/oc000265
urn:nbn:de:0183-oc0002654
Case Report
Multimodal imaging observation of torpedo maculopathy
Duan
Duan
Hongtao
H
Tianjin Eye Hospital, Tianjin, China
author
Dong
Dong
Meng
M
Tianjin Eye Hospital, Tianjin, China
author
Xie
Xie
Shiyong
S
Tianjin Eye Hospital, Tianjin, China
author
Zhang
Zhang
Tongmei
T
Tianjin Eye Hospital, Tianjin, China
author
Wu
Wu
Bin
B
Tianjin Eye Hospital, Tianjin, China
author
Zheng
Zheng
Yuezhong
Y
Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Nankai University Affiliated Eye Hospital, Tianjin 300000, ChinaTianjin Eye Hospital, Tianjin, China
eye2002@163.com
author
German Medical Science GMS Publishing House
Düsseldorf
610
20260120
engl
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung).
2193-1496
16
GMS Ophthalmology Cases
GMS Ophthalmol Cases
01
Tianjin Key Medical Discipline Construction
An 18-year-old male was discovered with an oval, 1PD-sized, well-defined lesion on the inferonasal fovea of the right eye. Multimodal imaging was carried out. The lesion was diagnosed as torpedo maculopathy (TM). Most TM patients have no visual symptoms, are often detected during routine examination, and are generally stable.
IntroductionTorpedo maculopathy (TM) is a rare, congenital condition affecting the retinal pigment epithelium (RPE) layer. The terminology was first coined by Daily . Roseman and Gass earlier described a similar lesion referred to as “RPE hypochromic nevus”. Typically, TM is on the macula’s temporal side, tip towards the fovea.
Case descriptionAn 18-year-old male was found with a fundus lesion due to physical examination. The visual acuity of both eyes was 1.0. He had no significant medical history, was born full-term, and had no family history of eye disorders. Both intraocular pressure and anterior segments were normal. In the right eye, an oval, 1PD-sized lesion was seen on the inferonasal fovea. The lesion had a slight acute angle along its long axis and contained irregular yellow-white dots. The retinal blood vessels over the lesion appeared normal. The fundus of the left eye was normal (Figur<![CDATA[e 1A</PlainText></TextGroup>–D <ImgLink imgNo="1" imgType="figure" />). Optical coherence tomography (OCT) revealed structural disturbances in the outer layer of the retina, characterized by cleavage and a slightly enhanced choroidal reflex beneath the lesion (Figure 1E <ImgLink imgNo="1" imgType="figure" />). In the early stage of fluorescein angiography, an oval-shaped hyperfluorescent lesion was observed, which remained hyperfluorescent in the late stage without leakage (Figur<TextGroup><PlainText>e 1F</PlainText></TextGroup>, G <ImgLink imgNo="1" imgType="figure" />). Indocyanine green fundus angiography demonstrated translucent choroidal vessels in the early stage, followed by hypofluorescent changes in the late stage (Figure 1H, I <ImgLink imgNo="1" imgType="figure" />). Based on these findings, the diagnosis was confirmed as torpedo maculopathy (TM). He was advised to undergo regular follow-up examinations.</Pgraph></TextBlock>
<TextBlock name="Discussion" linked="yes">
<MainHeadline>Discussion</MainHeadline><Pgraph>The exact etiology of TM remains unclear. Shields et al. <TextLink reference="3"></TextLink> hypothesized that arose from improper development of the RPE in the fetus, potentially influenced by the location and size of lesion. The congenital nature of the lesion, as concluded by Pian et al. <TextLink reference="4"></TextLink>, resulted from incomplete differentiation of the arcuate tract along the horizontal median suture. This could lead to unusual shapes, such as torpedo-shaped lesion. Additionally, it had been proposed that disorders of the short ciliary arteries and veins, occurring before and after birth, might cause choroidal vascular dysplasia. It could damage RPE and contribute to the torpedo-like change <TextLink reference="5"></TextLink>. Recently, OCT angiography have identified the loss of the choroidal capillary layer in TM, providing support for this hypothesis. Furthermore, a congenital choroidal valgus hypothesis was proposed to explain that.</Pgraph><Pgraph>Wong et al. <TextLink reference="6"></TextLink> classified TM into two types based on characteristics identified through OCT. Type I TM presents with no outer retinal space and only minor disturbances in the outer retina, as well as possible thinning of the outer nuclear layer. Type II TM, on the other hand, shows a structural disturbance in the outer retina characterized by a cleavage. In both types, the inner layer of the retina remains normal, while the reflected signal through the choroid is increased. It is important to note that this classification does not account for TM with structural alterations in the inner layer of the retina. Consequently, Type III TM, was characterized by a distinctive fundoscopic appearance and no subretinal space on OCT, and may be associated with retinal choroidal depression, retinal thinning <TextLink reference="7"></TextLink>, <TextLink reference="8"></TextLink>, <TextLink reference="9"></TextLink>.</Pgraph><Pgraph>Most patients with TM do not exhibit visual symptoms. They generally remain stable during follow-up <TextLink reference="10"></TextLink>. TM can also occur alongside other conditions, such as retinoblastoma <TextLink reference="11"></TextLink>, and congenital ocular toxoplasmosis <TextLink reference="12"></TextLink>. Patients without complications typically do not require treatment, and regular follow-up is sufficient for monitoring their condition. However, chorioretinal atrophy in the deep layer may result in complications like choroidal neovascularization and decreased visual acuity <TextLink reference="13"></TextLink>, <TextLink reference="14"></TextLink>.</Pgraph></TextBlock>
<TextBlock name="Conclusion" linked="yes">
<MainHeadline>Conclusion</MainHeadline><Pgraph>In conclusion, torpedo maculopathy (TM) is a rare eye condition that typically does not significantly affect visual acuity. Currently, our understanding of its etiology remains limited due to the small number of reported cases. With the continuous advancement of ophthalmic imaging technology, we anticipate gaining deeper insights into the pathological mechanisms, clinical characteristics, and natural course of this condition in the future.</Pgraph></TextBlock>
<TextBlock name="Notes" linked="yes">
<MainHeadline>Notes</MainHeadline><SubHeadline>Funding</SubHeadline><Pgraph>This work was supported by Tianjin Key Medical Discipline Construction (TJYXZDXK-3-004A-3).</Pgraph><SubHeadline>Competing interests</SubHeadline><Pgraph>The authors declare that they have no competing interests.</Pgraph></TextBlock>
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<Caption><Pgraph><Mark1>Figure 1: Multimodal imaging of the fundus in a patient with TM</Mark1></Pgraph></Caption>
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