This 21YO male patient with a known history of tuberous sclerosis was referred for multiple, asymptomatic, thickened whitish inner retinal lesions.
On fundus autofluorescence (FAF), these lesions are hyper-FAF. Surrounding hypo-FAF changes that extend into the macula are a sign of prior exudative fluid.
OCT scanning shows an elevated, hyperreflective inner retinal lesion with multiple hyporeflective intralesional cavities.
Learning Points:
A retinal astrocytic hamartoma is a benign tumor composed of spindle-shaped fibrous astrocytes located in the nerve fiber layer, most commonly associated with tuberous sclerosis.
Tuberous sclerosis includes the classic triad of seizures, intellectual disability, and fibroangiomas. Still, patients can have lesions throughout the body, including the eyes, skin (ash-leaf spots), bone, nails, teeth, brain, heart, lungs, and kidneys.
Early in life, the inner retinal lesions appear fleshy white and are often multifocal and bilateral. With time, as in this patient, they show a more classic “mulberry appearance” with significant calcification. Rarely, the vascular component can cause intraretinal exudation requiring treatment.
