Torpedo Maculopathy

An asymptomatic 50-year-old male was referred to our institute for examination of a retinal lesion observed temporal to the macula in the left eye. A complete ophthalmic examination was performed with multimodal imaging techniques including fundus photography, fundus autofluorescence (FAF), optical coherence tomography (Topcon Triton Swept-source OCT; Topcon Corporation, Tokyo, Japan), en face OCT, and OCT angiography (OCT-A). His best corrected visual acuity (BCVA) was 20/20, N6 in both eyes. Fundus examination of the left eye revealed a well-defined bullet- or torpedo-shaped lesion observed 2 disc diameter (DD) temporal to the fovea [Figure 1(A)]. The lesion was hypopigmented in nature with a small area of hyperpigmentation at the tail end. FAF showed hypoautofluorescence with a ring of hyperautofluorescence at the tail end of the lesion [Figure 1(B)]. OCT showed normal inner retinal layers, attenuation of the inner segment–outer segment zone with atrophy of the outer nuclear layer, mild outer retinal cavitation, and increased choroidal reflectance [Figure 1(C)]. There was no evidence of any subretinal cleft. Infrared reflectance OCT imaging focused on the choriocapillaris layer revealed a heterogenous area of reflectivity corresponding to the extent of the lesion, with surrounding hyperreflectivity at the tail [Figure 1(D)]. OCT-A segmentation at the superficial capillary plexus was normal, while the choriocapillaris layer showed diffuse attenuation of flow signals with a convoluted pattern of fine vessels and a few empty spaces between them [Figure 1(E)].