Abstract
PurposeTo investigate the clinical findings and differential diagnosis of incidental unilateral discoid maculopathy in a case series of children.MethodsThe medical records and retinal imaging of children referred to a single center for flat, well circumscribed, hypopigmented discoid macular lesion in the left eye were reviewed retrospectively.ResultsThree children (age range, 4-11 years; 2 female), with no subjective ophthalmic complaints, were referred for investigation of a flat, well-circumscribed, hypopigmented discoid macular lesion in the left eye. Case 1 had a history of viral mesenteric adenitis, and case 2 had a history of hand, foot, and mouth disease. For case 3, no previous history of systemic viral infection was established. Snellen visual acuity was 20/20 for all 3 children. The lesion was located superior to the fovea for case 1 and centered to the fovea for cases 2 and 3, all in the left eye. In all 3 patients, hyperautofluorescent changes were noted around the edges of the lesion, which was roughly discoid. OCT showed subtle changes of the interdigitation zone and retinal pigment epithelium (RPE) for cases 1 and 2. In case 3 the presence of hyperreflective, hypertrophic tissue at the level of the interdigitation zone and/or the RPE was noted.ConclusionsIn these 3 children with subclinical, unilateral discoid maculopathy sharing common features and identified incidentally, previous viral illness may have been causative. These cases may represent resolved unilateral acute idiopathic maculopathy.
Highlights
The medical records and retinal imaging of children referred to a single center for flat, well circumscribed, hypopigmented discoid macular lesion in the left eye were reviewed retrospectively
The differential diagnoses that could be considered in these cases include congenital hypertrophy of the retinal pigment epithelium (RPE) and atypical North Carolina macular dystrophy
unilateral acute idiopathic maculopathy (UAIM) and ARPE can be differentiated on Optical coherence tomography (OCT): UAIM shows swelling of the outer retina with presence of hyperreflective exudation and neurosensory retinal detachment,[9] whereas ARPE shows a dome-shaped hyper-reflective lesion at the photoreceptor outer segment layer,[3] which occasionally can involve the full thickness of the fovea.[10]
Summary
To investigate the clinical findings and differential diagnosis of incidental unilateral discoid maculopathy in a case series of children. The medical records and retinal imaging of children referred to a single center for flat, well circumscribed, hypopigmented discoid macular lesion in the left eye were reviewed retrospectively. In case 3 the presence of hyperreflective, hypertrophic tissue at the level of the interdigitation zone and/or the RPE was noted In these 3 children with subclinical, unilateral discoid maculopathy sharing common features and identified incidentally, previous viral illness may have been causative. Journal of AAPOS a case series of 3 children with a benign, unilateral discoid maculopathy, sharing common features, identified incidentally, and referred to a tertiary eye center for further investigation
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