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Multi-modal imaging in benign familial fleck retina

Kumar, Nitin; Balyan, Monika; Bansal, Reema

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Indian Journal of Ophthalmology: June 2021 - Volume 69 - Issue 6 - p 1641
doi: 10.4103/ijo.IJO_633_21
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We have a clarification for our article “Multi-modal imaging in familial dominant drusen”, published in IJO.[1] This clinical picture is more likely suggestive of benign familial fleck retina, rather than familial dominant drusen. Hence, we make the following modifications in the manuscript.

A 42-year-old woman came for routine check-up with 20/20 vision. Fundus examination revealed bilateral, numerous, subretinal, yellowish-white lesions of variable sizes, with a symmetrical pattern, suggestive of benign familial fleck retina [Fig. 1a and b]. Extending from the vascular arcades, and arranged in a concentric pattern, the flecks spread all over the mid and far periphery, sparing a small island of macula. Fundus autofluorescence revealed bright hyperautofluorescence of the lesions [Fig. 1c and d]. Optical coherence tomography scans showed thickened retinal pigment epithelium-bruchs membrane complex with localized elevations [Fig. 1e and f].

Figure 1
Figure 1:
(a-e) Ultra widefield fundus photographs showing bilateral, numerous, yellowish-white, closely spaced lesions of variable sizes, extending from the vascular arcades till the periphery, sparing a small island of the macula (a and b), Fundus autofluorescence revealed bright hyperautofluorescence of the lesions (c and d). Optical coherence tomography scans of both eyes showing thickening of RPE-Bruchs complex with dome shaped RPE elevations (red arrows) and relative non-involvement of neurosensory retina corresponding to the flecks (e and f)

The flecks have a flat surface, are well-defined with sinuous borders. No other findings associated with retinal pigment epithelium (pigmentation) or choroidal changes (vascular prominence) were seen. This phenotype has a classical macular sparing, with no area spared in periphery, has an autosomal recessive inheritance and is considered in the differential of flecked retina diseases: Fundus albipunctatus, fundus flavimaculatus, fleck retina of Kandori, and familial drusens.[2345]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

1. Kumar N, Balyan M, Bansal R. Multi-modal imaging in familial dominant drusen Ind J Ophthalmol. 2020;68:2266
2. Aish SFS, Dajani B. Benign familial fleck retina Br J Ophthalmol. 1980;64:652–9
3. Galindo-Ferreiro A, Sanabria MR, Garcia EP, Coco-Martin RM, Galindo-Alonso J, Palencia-Ercilla J. Benign fleck retinal findings on multifocal ERG, microperimetry, and OCT Ophthalmic Surg Lasers Imaging. 2010:41 Online: e1-5
4. Garcia JMBB, Isaac DLC, Sardeiro T, Aquino E, Avila M. Benign familial fleck retina: Multimodal imaging including optical coherence tomography angiography Arq Bras Oftalmol. 2017;80:321–3
5. Gupta S, Jain S, Kumar V. Benign familial fleck retina JAMA Ophthalmol. 2019;137:e185539
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