Tumour-associated retinal pigment epitheliopathy

Choroidal tumours are associated with several degenerative changes in the overlying tissues, which can be called 'Tumour-Associated Retinal Pigment Epitheliopathy (TARPE)'. These changes include (i) proliferation, detachment, atrophy, and metaplasia of the retinal pigment epithelium, (ii) the accumulation of hard and soft drusen and basal laminar deposits in Bruch's membrane, (iii) disorganisation of the choriocapillaris, (iv) atrophy, cystic degeneration and detachment of the retina. The changes at the chorio-retinal interface are clinically relevant because they can exacerbate visual loss. In addition, they can be misinterpreted on ophthalmoscopy and fluorescein angiography. An amelanotic choroidal tumour may appear to be pigmented on ophthalmoscopy because of lipofuscin and melanin accumulation overlying the tumour. The hyperfluorescence associated with pigmented choroidal melanomas is more likely to be related to degenerative changes in the retinal pigment epithelium than to dye leakage from abnormal tumour vessels.