Choriocapillaris Alterations in Type 1 and Type 2 Torpedo Maculopathy: A Multimodal Imaging Case Series

Background: Torpedo maculopathy is an uncommon, usually asymptomatic chorioretinal lesion temporal to the fovea. Optical coherence tomography (OCT) distinguishes a non-cavitary type 1 from a cavitary type 2 phenotype, but choriocapillaris involvement in these phenotypes remains incompletely defined. This report describes the choriocapillaris findings in one patient with each phenotype. Methods: Two women with unilateral torpedo maculopathy, aged 18 (type 1) and 52 years (type 2), underwent multicolor imaging, fundus autofluorescence, spectral-domain OCT, and OCT angiography, which were assessed qualitatively. Results: Best-corrected visual acuity was 20/20 in both eyes of each patient. Both lesions showed outer-retinal changes and topographic correspondence between fundus autofluorescence abnormalities and choriocapillaris flow-signal attenuation. In the type 1 lesion, the inner retinal layers were preserved without cavitation, and choriocapillaris attenuation was focal and relatively homogeneous. The type 2 lesion showed subretinal cavitation (subretinal cleft), focal attenuation of the retinal pigment epithelium–Bruch membrane complex, and a choriocapillaris flow deficit that appeared more extensive within the imaged region. Conclusions: These observations suggest involvement of the retinal pigment epithelium–choriocapillaris unit in both phenotypes. As they derive from one patient per phenotype at a single time point, they cannot be extended to the two subtypes; longitudinal imaging is required to define the temporal relationship between outer-retinal and choriocapillaris changes.