Simple Congenital Hamartoma of the Retinal Pigment Epithelium

An asymptomatic 63-year-old woman presented for annual ophthalmic examination at University of Texas Medical Branch eye clinic and was found to have a simple congenital hamartoma of the retinal pigment epithelium (RPE) in the left eye. The best corrected visual acuity was 20/20 and the visual field was within normal limits. On fundus examination, a circular hyperpigmented retinal lesion measuring less than the diameter of an optic disc was detected superonasal to the fovea. Old records indicated that the lesion had been present since at least 12 years before, showing no significant morphological changes on serial fundus photographs [Figures 1A and 1B] The lesion showed hypoautofluorescence in autofluorescence imaging [Figure 2A] and optical coherence tomography (OCT) revealed high surface reflectivity with deep optical shadowing and full-thickness retinal involvement that had been stable over time [Figures 2A and 2B]. Bscan ultrasonography revealed a flat lesion showing medium to high internal reflectivity [Figure 2C].