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Ophthalmology and Visual Sciences

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Retinal Astrocytic Hamartomas

Contributor: Jesse Vislisel, MD

Category: Retina

March 8, 2013

Retinal astrocytic hamartomas are the most common ocular finding of tuberous sclerosis complex. Note the obvious calcified astrocytic hamartomas in both eyes, commonly referred to a "mulberry lesions" due to their multinodular appearance. The right fundus also contains a more subtle non-calcified astrocytic hamartoma which can be spotted as a hazy area overlying the superotemporal arcade.

Right eye

Right eye, retinal astrocytic hamartomaRetinal astrocytic hamartomas

Left eye

Left eye, retinal astrocytic hamartom


Noncalcified Astrocytic Hamartoma in the setting of Retinitis Pigmentosa

Contributor: Morgan Bertsch, BS and Tyler B.S. Risma, MD

Posted May 12, 2017

This patient with a history of autosomal recessive retinitis pigmentosa (RP) presented with an amelanotic juxtapapillary retinal lesion consistent with noncalcified astrocytic hamartoma of the left eye. Astrocytic hamartomas are typically associated with tuberous sclerosis or neurofibromatosis, but unilateral solitary lesions have been seen in otherwise normal patients. Several cases of bilateral and unilateral astrocytic hamartomas in the setting of RP have been documented. Calcified astrocytic hamartomas appear as white nodular lesions with patchy calcifications overlying the optic disc with a classic "mulberry" appearance. Non-calcified astrocytic hamartomas appear as flat, soft, smooth-appearing, translucent or semi-translucent lesions. It is important to differentiate a calcified astrocytic hamartoma from optic nerve drusen, which is more commonly found in association with RP.

patient with a history of autosomal recessive retinitis pigmentosa (RP) presented with an amelanotic juxtapapillary retinal lesion consistent with noncalcified astrocytic hamartoma of the left eye. patient with a history of autosomal recessive retinitis pigmentosa (RP) presented with an amelanotic juxtapapillary retinal lesion consistent with noncalcified astrocytic hamartoma of the left eye.


Tuberous Sclerosis with Optic Nerve Hamartoma

Category(ies): Inherited Eye Diseases

  • Pediatrics
  • Retina / Vitreous

Contributor: Aaron M. Ricca MD

September 18, 2017

 

This patient is a 9-year-old female with tuberous sclerosis and an optic nerve hamartoma of the right eye, which in this case appears similar to unilateral optic disc swelling. She has subretinal fluid adjacent to the optic nerve and over the domed hamartoma, as visualized on optical coherence tomography (OCT) of the retina. Note that she has atrophy of the retinal pigmented epithelium (RPE) in the area of subretinal fluid in a "water mark" fashion. A large choroidal nevus is visible under the inferior arcade. Fortunately, her visual acuity remains 20/20, as the subretinal fluid spares the fovea.

References

  1. Bec P, Mathis A, Adam P et al. Retinitis pigmentosa associated with astrocytic hamartomas of the optic disc. Ophthalmologica 1984;189:135-138 doi:10.1159/000309399. https://PubMed.gov/6493693
  2. Ambiya V, Kuppermann BD, Narayanan R. Retinal astrocytic hamartoma in a patient with Leber's congenital amaurosis. BMJ Case Rep. 2015 Mar 3;2015. doi: 10.1136/bcr-2014-208374. https://PubMed.gov/25737223
  3. Grover S, Fishman GA, Brown J., Jr Frequency of optic disc or parapapillary nerve fiber layer drusen in retinitis pigmentosa. Ophthalmology. 1997;104:295–298. https://PubMed.gov/9052635
  4. Loukianou E, Kisma N, Pal B. Evolution of an Astrocytic Hamartoma of the Optic Nerve Head in a Patient with Retinitis Pigmentosa - Photographic Documentation over 2 Years of Follow-Up. Case Rep Ophthalmol. 2011 Feb 2;2(1):45-49. doi: 10.1159/000324037. https://PubMed.gov/2134719

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last updated: 03/08/2013; addition made 9/18/17
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