57. A 47-year-old with butterfly-shaped lesions
This 47-year-old patient presented to us with blurred vision. On examination there is clear pathology located at the deepest layers of the retina.
To the left of the image, there is loss of the ellipsoid layer (this is the junction of the outer and inner retinal segments). Additionally, there is evidence of hyperreflectivity located at or below the ellipsoid layer and above the retinal pigment epithelium (RPE). Lastly, there is elevation and thickening of the RPE. The clinical examination was consistent with butterfly-shaped yellowish lesions located in the deep retina; a diagnosis of pattern dystrophy was made.
In patients with pattern dystrophy, the OCT demonstrates hyperreflectivity between the ellipsoid and RPE. This is due to unfagocytosed material from the outer segments. The material in the RPE is lipofuscin.
In anyone with deep retinal hyperreflectivity, always consider pattern dystrophy in the differentlal diagnosis.
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