A 72-year-old Caucasian man was referred to us for a pigmented lesion in the fundus of the right eye seen on routine examination. He denied symptoms of visual loss, flashes or floaters. He had no significant ocular history and his medical history was significant only for hypertension.
Imaging with a red filter revealed a flat, polypoidal, primarily hyperabsorbent lesion with well-delineated and granular areas of hypoabsorbance throughout (including a partial rim of hypoabsorbance superiorly). The increased melanin content of the retinal pigment epithelium accounted for the hyperabsorbant areas. Likewise, the hypoabsorbant areas correspond to areas of either absent RPE (well-delineated lacuna temporally) or less-pigmented RPE (superior rim). These findings are consistent with congenital hypertrophy of the retinal pigment epithelium.
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