Outer Retinal Tubulation: A Case Series

• Published in: Optometry and vision science Vol. 94; no. 3; pp. 423 - 431
• Main Authors: Rousso, Leticia A, Rodman, Julie A, Sutton, Brad, Shechtman, Diana L
• Format: Journal Article
• Language: English
• Published: United States American Academy of Optometry 01.03.2017
• Subjects: Aged; Aged, 80 and over; Choroid Diseases - complications; Eye Infections, Fungal - complications; Female; Histoplasmosis - complications; Humans; Male; Middle Aged; Myopia, Degenerative - complications; Retinal Dystrophies - diagnosis; Retinal Dystrophies - etiology; Retinal Photoreceptor Cell Outer Segment - pathology; Retinal Pigment Epithelium - pathology; Tomography, Optical Coherence; Wet Macular Degeneration - complications
• ISSN: 1040-5488; 1538-9235
• DOI: 10.1097/OPX.0000000000001056

PURPOSEThe advent of spectral domain optical coherence tomography has led to superb imaging capabilities in addition to enhanced visualization of the retinal layers. Such advancements have led to the identification of a variety of new retinal conditions, including outer retinal tubulations (ORTs). ORTs are ovoid hyporeflective spaces located in the outer retina. The pathogenesis is unclear but seems to involve sublethal injury to the photoreceptors leading to a compensatory reorganization of the photoreceptor layer with the neighboring ellipsoid zone resulting in a hyperreflective border surrounding a central lumen. Most ORTs have been linked to wet age-related macular degeneration; however, these peculiar structures are now seen in a myriad of retinal disorders. CASE REPORTSOur cases will highlight the wide variety of clinical presentations associated with outer retinal tubulations. The clinical presentations include two cases of wet age-related macular degeneration, a case of presumed ocular histoplasmosis syndrome, a case of central areolar choroidal dystrophy, and a case of pathological myopia. CONCLUSIONSBy correctly differentiating outer retinal tubulations from other masqueraders, unnecessary referrals and interventions can be minimized. Understanding the various disease entities associated with outer retinal tubulation could give further insight into the mechanism and formation of these structures.