A 40-year-old lady came to the clinic with presbyopic complaints since 1 month. Her best corrected visual acuity was 20/20, N6 (OU). Anterior segment evaluation as well as Intraocular pressure was within normal limits (WNL). Fundus examination of left eye (OS) revealed a well circumscribed, elevated and opaque lesion 3 × 2.4 mm in size along the inferior arcade [Fig. 1a]. Right eye fundus was WNL. Autofluorescence showed moderate hyperaurofluorescence of the mass [Fig. 1b]. Optical coherence tomography (OCT) through the lesion showed an elevated non-calcified lesion arising from superficial retinal layers with obscuration of deeper retinal layers with intense posterior shadowing [Fig. 1c]. On OCT-A the mass appeared avascular with superficial retinal vessels of normal caliber traversing through or around it with obscuration of deeper retinal vessels [Fig. 1d]. There were no systemic features of Tuberous sclerosis or Neurofibromatosis. On one year follow-up, the visual acuity remained stable with no observed growth.
Shields et al. described such a lesion as presumed solitary circumscribed retinal astrocytic proliferation. These lesions are solitary, superficial, well circumscribed white lesions in eyes with clear media and no prior ocular insults. Patients are asymptomatic and the mass tends to remain stable with no documented growth.
This lesion should be differentiated from Retinal Astrocytic Hamartomas (RAH) which usually are associated with Tuberous Sclerosis or Neurofibromatosis. RAH are nodular yellow lesions with less well-defined margins, which may or may not be calcified usually presenting in pediatric age group.
Another retinal glial tumor that PSCRAP should be differentiated from is acquired retinal astrocytoma. ARA is a vascular tumor exhibiting a more aggressive clinical course, with enlargement and profuse exudation with resultant visual impairment.
This photo essay highlights the unique clinical features and imaging signatures of PSCRAP and outlines the important differentiating features from other retinal glial tumors.
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