Multimodal imaging of combined harmatoma of the retina and retinal pigment epithelium

Abstract

PurposeTo describe the use of multimodal imaging in defining the anatomical features of combined harmatoma of the retina and retinal pigment epithelium (CHRRPE) and assess its role in the diagnosis and management of CHRRPE.MethodsRetrospective case series of three patients with unilateral, juxta‐papillary CHRRPE, who underwent Spectralis Enhanced Depth Imaging Optical Coherence Tomography (EDI‐OCT), MultiColor (MC) and autofluorescence (AF) in addition to a complete ophthalmic examination.ResultsEDI‐OCT demonstrated thickening and disorganisation of retinal architecture, with intraretinal cysts disrupting the retinal layers and a loss of photoreceptors. An overlying epiretinal membrane was shown to be causing ‘mini‐peaks’ of the inner retinal surface in all cases and vitreoretinal traction in two cases. Details of the retinal pigment epithelium (RPE) were revealed, including RPE thickening and sectoral atrophy. MC revealed areas of red‐shifting, demonstrating partial pigmentation. On green reflectance (GR) the degree of inner retinal distortion and extent of macular involvement could be visualised. Near infra‐red (NIRR) reflectance displayed the lesions as areas of hyporeflectance and allowed delineation of the tumour borders. On AF, the lesions were represented by areas of hypo‐autofluorescence that obscured the normal blood vessel hypo‐autofluorescence.ConclusionsIn this case series, multimodal imaging enabled the anatomical characteristics of CHRRPE to be defined in greater detail. NIRR enabled better visualisation of tumour boundaries and the extent of macular involvement, which may be useful in assessing the impact on visual function. GR better defined the degree of inner retinal distortion, which may be useful in surgical management decisions. We believe that multimodal imaging is a valuable adjunct in correctly diagnosing and managing CHRRPE.