Hamartoma of the optic disc and the retinal pigment epithelium

A combined hamartoma of the optic disc and the RPE may show as a submacular CNV or/ and an epimacular gliosis. In this example the visual acuity is 20/200 and stable but metamorphopsia is a constant complaint. The surgical approach aims to release epiretinal traction via ILM peeling and thereby improve the metamorphopsia.

No epiretinal tissue is found, since the ILM stains homogenously. A fibrous tuft is peeled from the optic disc. Since in angiography there is no leakage from the subretinal RPE and no CNV, no subretinal membrane extraction is attempted. In concluding the retinal periphery is inspected an a fresh horseshoe tear is detected at 3 hours, not associated with the sclerotomy and addressed by cryopexy.