![]() Congenital hypertrophy of the retinal pigment epithelium (CHRPE) in familial colorectal cancer. Chen CS, Phillips KD, Grist S, Bennet G, Craig JE, Muecke JS, Suthers GK. Congenital hypertrophy of retinal pigment epithelium (CHRPE) in patients with familial adenomatous polyposis (FAP) a polyposis registry experience. Nusliha A, Dalpatadu U, Amarasinghe B, Chandrasinghe PC, Deen KI. Solitary congenital hypertrophy of the retinal pigment epithelium: clinical features and frequency of enlargement in 330 patients. Shields CL, Mashayekhi A, Ho T, Cater J, Shields JA. 6-8 In the periphery, they may remain stable with the exception of depigmented appearance, as this case illustrates.ġ. CHRPE lesions have been reported to change over time.Ĭentral presentations may interfere with visual acuity. 5 The present case was not evaluated perimetrically because the lesion was well anterior of the equator. Histologically, geographic CHRPE lesions displace the overlying photoreceptor cells, resulting in a scotoma. Single lesions could be present among certain at-risk patients such extra-colonic manifestations should be followed up. 2,3,4Īlthough controversy surrounds the connection, bilaterality and numerous small presentations (sometimes referred colloquially as “animal” or “bear tracks”) seem to be the most consistent indicator for a gastrointestinal consultation. Variations have been associated with familial adenomatous polyposis (FAP). Related: A closer look at the retina in multiple sclerosisĪs the clinical descriptor suggests, these lesions are present at birth. Another distinct example of a solitary CHRPE lesion is shown in Figure 3. ![]() These lesions are generally round and demonstrate a halo of atrophy, hence the moniker “halo nevus” used incorrectly by some. With the depigmentation of the lesion evident, it became clear that the diagnosis is CHRPE. The exception was the appearance of the peripheral lesion that was observed at the initial visit (see Figure 2). The history and physical findings were unchanged. The patient was seen at the same clinic five years later for follow-up. The patient was questioned specifically regarding the risk pool for toxoplasmosis exposure-all of which she denied. With the exception of a recurrence of a toxoplasmosis lesion, standard vigilance is appropriate with admonition regarding floaters and blurred vision, potentially indicative of reactivation. Whether the fundus appearance is due to CHRPE or a post-inflammatory scar, there is little that would alter observation about the clinical course. Choroidal nevus emerges in the realm of pigmented fundus lesions but would be ruled out by the persistence of the pigmented lesion in its entirety when viewed with red-free light. In the absence of a history of trauma, the field narrows. Related: Eye punch leads to choroidal rupture Considerations include post-inflammatory/infectious, post-traumatic, and congenital (e.g., congenital hypertrophy of RPE ) entities. These diagnoses involve disturbance of the retinal pigment epithelium (RPE). Given the clinical findings, the differential diagnoses are not limitless. She was unable to recall any periods of significant ocular redness or treatment for infection. On further questioning, the patient denied episodes of blurred vision and blunt ocular trauma. Semes: The case of the blurred disc margins There was no perception of elevation or cellular response associated with the lesion. The pigmented characteristics of the area remained visible with red-free light. Dilated fundus examination revealed a normal-appearing posterior pole in each eye and peripheral pigmented lesion in the superior temporal region of the right eye (see Figure 1). Her intraocular pressure measured 16 mm Hg OD and 17 mm Hg OS. ![]() The anterior segment and contact lens evaluations were unremarkable in each eye. Visual acuity was correctable to 20/20 in each eye. The patient denied eye pain, discharge, double-vision, color perception abnormalities, redness, itch, and previous ocular surgery. The medical, family, and medication histories were non-contributory. Her history was significant for myopic refractive correction, for which she wore soft contact lenses successfully. Alabama School of Optometry clinic for a periodic ophthalmic evaluation.
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