Case ReportINVISIBLE, HONEYCOMB-LIKE, CAVITARY RETINAL ASTROCYTIC HAMARTOMAMellen, Phoebe L. MD; Sioufi, Kareem MD; Shields, Jerry A. MD; Shields, Carol L. MDAuthor Information Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania. Reprint requests: Carol L. Shields, MD, Ocular Oncology Service, Suite 1440, Wills Eye Hospital, 840 Walnut Street, Philadelphia, PA 19107; e-mail: email@example.com Supported by Eye Tumor Research Foundation, Philadelphia, PA (J.A.S., C.L.S.). None of the authors has any financial/conflicting interests to disclose. The funders had no role in the design and conduct of the study, in the collection, analysis and interpretation of the data, and in the preparation, review or approval of the manuscript. C. L. Shields has had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Retinal Cases & Brief Reports: Summer 2020 - Volume 14 - Issue 3 - p 211-214 doi: 10.1097/ICB.0000000000000697 Buy Metrics AbstractIn Brief Purpose: To report a patient with clinically invisible retinal astrocytic hamartomas (RAHs) detected on optical coherence tomography (OCT) and studied with OCT angiography (OCTA). Method: Case report. Results: An 11-year-old healthy girl was evaluated for reduced visual acuity in the right eye. On examination, best-corrected visual acuity was 20/50 in the right eye and 20/20 in the left eye. Fundus examination revealed blunted foveal reflex in the right eye and normal findings in the left eye. Optical coherence tomography disclosed an abruptly elevated, honeycomb-like macular mass with thin filamentous walls in the right eye, limited to the nerve fiber layer and measuring 756 μm in thickness. The numerous intralesional cavities (optically empty spaces) displayed no calcification. These findings were consistent with Type IV RAH. Optical coherence tomography of the left eye revealed intact foveola and focal nerve fiber layer thickening inferiorly without cavity, measuring 136 μm in thickness, consistent with Type I RAH. En face OCTA detected microvascular flow within the walls of the cavitary RAH in the right eye. Bilateral RAH in a child with no systemic evidence of tuberous sclerosis syndrome was established. Conclusion: Multimodal imaging is important in revealing causes of visual loss and in the detection of subclinical fundus tumors. In this case, clinically invisible RAHs were detected only by OCT and surrounding vascular flow by OCTA. Multimodal imaging detected bilateral retinal astrocytic hamartomas not readily seen on funduscopy. Optical coherence tomography angiography demonstrated flow surrounding multiple invisible, honeycomb-like retinal astrocytic hamartomas cavities.