Torpedo maculopathy: in-vivo histology using optical coherence tomography

Recent reports of torpedo maculopathy have disclosed underlying irregularities within the chorioretinal tissue that have not been shown to induce disturbances in visual function. Optical coherence tomography (OCT) provides a unique means of assessing the chorioretinal organization and integrity of torpedo lesions in an in vivo setting that has yet to be explored. In agreement with reported cases, torpedo maculopathy appears to be a benign, non-progressive condition that subtends the horizontal raphe in the juxtafoveal region and imparts no disturbance in visual function.

Three cases of torpedo maculopathy were examined using Stratus OCT3 imaging (Carl Zeiss Meditec, Dublin, CA). OCT scans revealed intact, attenuated retinal layers with hyper-reflectivity of the retinal pigmented epithelium (RPE). The RPE subtending these lesions appears of normal thickness, yet, there is an abrupt transition between intact-organized and intact-disorganized retinal tissue in scans transitioning from normal retina to torpedo lesions. Our imaging studies revealed significant attenuation and disorganization of the inner and outer retinal layers overlying a hyper-reflective RPE, which was of normal thickness and devoid of any structural defects.

An analysis of the OCT images collected suggests anomalies in retinal architecture. This finding implies that these lesions may represent atypical colobomas whereby retinal tissues are present but, perhaps, not fully developed. In light of these imaging studies, we propose that this uncommon condition may arise from deficits in cellular migration and/or organization.