Introduction
Presumed solitary circumscribed astrocytic retinal proliferation (PSCRAP) is a rare, benign retinal tumor that is typically discovered incidentally on examination. Usually, it is seen in White middle-aged male patients as an isolated lesion in the posterior pole. Although its location was originally thought to be the inner neurosensory retina, recent imaging studies with optical coherence tomography (OCT) angiography suggests it arises from the deep retina or retinal pigment epithelium (RPE). , Vision is usually preserved, and patients are asymptomatic. PSCRAP shows stability in size, but sometimes it can regress spontaneously. , Here we present a case of isolated PSCRAP in a patient referred for an incidental asymptomatic retinal finding.
History of present illness and examination
A 74-year-old White male patient with mild chronic obstructive pulmonary disease and hyperopia was referred for retina evaluation. The patient denied any visual symptoms including photopsias, floaters, nyctalopia, or metamorphopsia.
Ocular exam findings
On examination the visual acuity was 20/20 in the right eye and 20/25 in the left eye, intraocular pressure was 15 mm Hg in both eyes, and there was mild nuclear sclerosis in both eyes. Dilated fundus examination of the right eye revealed a well-circumscribed, elevated solid white lesion that was 3 mm temporal to the macula and appeared to be emanating from the retina ( Fig. 68.1 ). The lesion was surrounded by a rim of pigment mottling that measured 1.0 mm circumferentially. Additionally, there was a choroidal nevus with overlying drusen in the inferonasal midperiphery measuring 5 mm × 6 mm. The left fundus was normal without retinal lesions, drusen, or pigmentary changes.
Differential diagnosis
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Astrocytic hamartoma
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Retinoblastoma
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Retinocytoma
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Simple congenital RPE hamartoma
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Myelinated retinal nerve fibers
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Granuloma
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Reactive gliosis
Work up and imaging
OCT revealed an elevated lesion arising from the junction of the inner neurosensory retina and RPE ( Fig. 68.2 ). The fluorescein angiogram showed early blockage with a rim of mottled staining surrounding the lesion ( Fig. 68.3 ). Ultrasonography showed a 1.75-mm thick homogenous lesion ( Fig. 68.4 ) with medium internal reflectivity and no detectable spontaneous vascular activity or shadowing. Humphrey 24-2 visual field testing revealed a small nasal defect corresponding to the lesion temporal to the macula ( Fig. 68.5 ).
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