Torpedo Retinopathy

Abstract

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.”

<p>Choroidal Cavitary Disorders</p>

“…101 Spectral domain OCT demonstrates a thin RPE layer with increased signal transmission to the choroid, occasional loss of the ellipsoid zone line, and no overlying neuroretinal changes. 80,85,104,105 Wong et al classified two types of TM lesions based on the presence of outer retinal and/or choroidal cavitation. Type 1 was defined by having attenuation of the outer retinal structures without retinal or inner choroidal cavitation; Type 2 featured attenuation of the outer retinal structures with subretinal cavitation.…”

“…Type 1 was defined by having attenuation of the outer retinal structures without retinal or inner choroidal cavitation; Type 2 featured attenuation of the outer retinal structures with subretinal cavitation. 97 Torpedo lesions that contain choroidal excavation were recently classified as type 3 TM by Tripathy et al and studied by Venkatesh et al [105][106][107] Cavitation appears as an optically empty space on OCT as a result of thinning or loss of the outer retinal layers or choroidal layers. The distinction between cavitation and a neurosensory detachment that occurs in some cases can be made on the basis of preservation of retinal layer thickness in a detachment and attenuation or loss in cavitation.…”

“…97 It is speculated that the outer retinal excavation in the type 2 variant is created by loss of photoreceptors and/or RPE. 87,103,105 However, thinning and disruption of the retinal layers is variable and may be due to the chronicity of the lesion or phenotypic differences. 104 The cavitation can be distinguished from the SRF found in other causes such as CSC by the absence of ragged photoreceptors.…”

“…97 Five of eight patients with a type 1 lesion were tested on a Humphrey field analyzer or microperimeter with only 1 patient demonstrating ascotoma. [100][101][102][103][104][105][106][107][108][109][110][111][112] All patients with type 2 lesions had documented scotomas. 96,101,113 The variability between visual field defect and lesion may be due to the size of the TM lesions falling beneath the detection sensitivity of Humphrey field testing.…”

“…114 Additional studies have revealed a reduced capillary density within the choriocapillaris using OCT-A. 101,105 Some reports have shown normal 91,118 large caliber vessels of Sattler's and Haller's layer while others show them to be mildly attenuated. 117 Giannakaki-Zimmermann et al suggested since the TM lesion extends into the choriocapillaris, congenital choroidal malformation is involved.…”