Spontaneous Resolution of a Combined Hamartoma in a One-Year-Old Child

The combined hamartoma of the retina and the retinal pigment epithelium (CHR-RPE) is a rare but histologically benign tumor of which no clear consensus exists regarding its appropriate management. Most commonly CHR-RPE presents unilaterally in children as an elevated, pigmented lesion associated with vascular tortuosity and an epiretinal membrane (ERM). Patients may have decreased visual acuity (VA) in the affected eye, notably if the overlying ERM extends into the macula. For this reason, surgical intervention in the form of ERM removal has been pursued with notable success. Still, those who pursue observation cite the interwoven nature of the overlying glial membrane within the dysplastic retina, complicating surgery and accounting for variability in post-operative VA success. Given the rarity of the tumor coupled with the scarcity of data on its natural evolution, clinicians who pursue observation cannot know for sure whether withholding surgical management is predisposing their patients to worse visual outcomes as compared to those patients who undergo ERM peel as first-line therapy. This case report will discuss an infant with clinically diagnosed CHR-RPE whose lesion showed significant regression after 6 months of observation. This success story should cause ophthalmologists to reconsider the management options at their disposal when faced with a case of CHR-RPE, and to call for further research to better define the risks of observation over surgical intervention. [Ophthalmic Surg Lasers Imaging Retina 2024;55:471-473.].