Horizontal Outer Retinal Tubulations in Healed Choroiditis

A 30-year-old male presented with a healed choroiditis lesion at the posterior pole, accompanied by a secondary choroidal neovascular membrane at the macula. Radial OCT scans through the macula [Figure 1a-d] reveal multiple horizontally oriented outer retinal tubulations (ORTs) appearing as ovoid hypo-reflective lumens surrounded by hyperreflective borders within the outer nuclear layer. The locations of these ORTs are marked by black asterisks on the fundus photograph. This image illustrates the adaptive efforts of surviving photoreceptors surrounding the area of outer retinal damage, attempting to establish new lateral connections with adjacent cells.[1]Figure 1: A fundus photograph shows a healed choroiditis lesion at the posterior pole, along with a secondary choroidal neovascular membrane at the macula. Radial OCT scans through the macula (a-d) demonstrate multiple horizontally oriented outer retinal tubulations (ORTs) (highlighted by yellow lines in a-d). The locations of these ORTs are indicated by black asterisks on the fundus photographThe striking feature in this case is the diffuse spread of ORTs across the macular region, suggesting extensive outer retinal disruption. These ORTs, while located in proximity to the area of choroiditis and choroidal neovascular membrane, extend laterally, demonstrating a widespread attempt by the surviving photoreceptors to form new lateral connections with neighbouring retinal cells. This adaptive process reflects the retina’s effort to reorganize its network and restore functionality after significant damage. The presence of multiple ORTs, spanning a wide area, indicates the severity of the retinal remodelling in response to outer retinal injury. Their widespread nature is a noteworthy phenomenon that may have implications for the pathophysiology of retinal diseases involving macular damage, as well as for the potential recovery or visual prognosis of such patients. The use of high-resolution OCT imaging allows for the precise identification of these tubulations, offering valuable insights into the extent of retinal degeneration and the underlying mechanisms of neural plasticity in the retina. The findings also underscore the importance of OCT in assessing retinal architecture and guiding clinical decision-making in conditions involving macular pathology. 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.