Multimodal imaging features of atypical multifocal torpedo maculopathy: a case report

Torpedo maculopathy (TM) is a rare congenital retinal abnormality, typically presenting as a solitary, torpedo-shaped hypopigmented lesion located temporal to the fovea with its apex pointing toward the fovea. Multifocal TM is exceedingly uncommon, and its multimodal imaging characteristics and lesion distribution remain incompletely understood. A 32-year-old man was referred after an incidental abnormality was detected in the fundus of his right eye. He was asymptomatic, with uncorrected visual acuity of 20/20 in both eyes. Color fundus photography revealed a typical torpedo-shaped lesion temporal to the macula and additional elongated temporal lesions with indistinct borders. OCT demonstrated focal RPE attenuation or loss, increased choroidal hypertransmission, and outer retinal involvement, with a slit-like subretinal cleft in one lesion. FFA showed multiple well-demarcated hyperfluorescent lesions without leakage, whereas ICGA revealed corresponding hypofluorescent areas and provided clearer delineation of lesion margins and extent. These findings supported the diagnosis of atypical multifocal torpedo maculopathy. Given the absence of symptoms and preserved visual function, no treatment was required and periodic follow-up was recommended. Multifocal TM may show atypical morphology on color fundus photography, with some lesions appearing poorly demarcated and their extent potentially underestimated. Integrated multimodal imaging, particularly OCT, FFA, and ICGA, enables a more comprehensive assessment of lesion morphology, distribution, and structural heterogeneity. Among these modalities, ICGA may provide additional value in delineating lesion boundaries and extent. This case further expands the imaging spectrum of multifocal TM and highlights the importance of integrated multimodal imaging in atypical presentations.