==== Front Indian J OphthalmolIndian J OphthalmolIJOIndian Journal of Ophthalmology0301-47381998-3689Medknow Publications & Media Pvt Ltd India 30038174IJO-66-118910.4103/ijo.IJO_192_18Photo EssayTorpedo maculopathy with double torpedoes Raju Biju Nooyi Chandrashekar 1Raju N S D 2Nidheesh Saritha 3Vitreoretinal Services, Dr. NSD Raju's Eye Hospital and Research Centre, Kochi, Kerala, India1 Vitreoretinal Services, Al Nadha Hospital, Ruwi, Muscat, Oman2 Cataract and Medical Retina, Dr. NSD Raju's Eye Hospital and Research Centre, Kochi, Kerala, India3 Department of Optometry, Dr. NSD Raju's Eye Hospital and Research Centre, Kochi, Kerala, India Correspondence to: Dr. Biju Raju, Dr. NSD Raju's Eye Hospital and Research Centre, “Ranjini” Near Powerhouse, Vyttila, Kochi - 682 019, Kerala, India. E-mail: drbijuraju@gmail.com8 2018 66 8 1189 1190 05 2 2018 17 4 2018 Copyright: © 2018 Indian Journal of Ophthalmology2018This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.DIYretCAMOCT angiographySmartphone Fundus PhotographySpectral Domain Optical Coherence TomographyTorpedo maculopathy ==== Body Case Report A 6-year-old male presented with defective vision in both eyes. Unaided vision was 6/36 in the right eye and 6/18 in the left eye. Best-corrected visual acuity improved to 6/18 with a correction of −2.00 DC at 180° in the right eye and to 6/9 in the left eye with −1.25 DC at 160°. Anterior-segment evaluation was unremarkable. Fundus evaluation in the right eye showed two torpedo-shaped lesions. The first torpedo lesion was typical of torpedo maculopathy [Fig. 1].[1] The second lesion was half-a-disc diameter inferior and almost parallel to the first lesion, with a closer resemblance to a “torpedo.” The second torpedo had a frayed tail temporally. Fundus evaluation in the left eye was within normal limits [Fig. 2]. Optical coherence tomography (OCT) of the superior torpedo showed Type I morphologic characteristics [Figs. 3 and 4]. The second lesion had attenuation of outer retinal layers along with a cavitation, consistent with the OCT appearance of a Type II lesion [Figs. 4 and 5]. The occurrence of double torpedoes in torpedo maculopathy has not been reported. Figure 1 Fundus photograph taken with a smartphone fundus documentation technique (DIYretCAM) showing double torpedoes. The superior torpedo is in the classic location as described in torpedo maculopathy. Note the frayed tail temporally in the inferior torpedo. The two white dots are reflection artifacts seen with smartphone fundus documentation techniques Figure 2 The left eye was normal clinically as well as on optical coherence tomography Figure 3 Optical coherence tomography of the first torpedo shows attenuation of outer retinal layers with thickened retinal pigment epithelial – Bruch's membrane complex described as Type I optical coherence tomography features of torpedo maculopathy (arrow) Figure 4 The vertical scan on optical coherence tomography passing approximately through the centers of both lesions showing the Type I and the Type II characteristics of the superior and inferior torpedoes, respectively Figure 5 Optical coherence tomography of the second torpedo shows presence of a subretinal cleft or outer retinal cavitation along with attenuation of outer retinal layers described as Type II features of torpedo maculopathy (arrow) The exact pathogenesis of torpedo maculopathy is unknown. The current hypotheses by Pian et al.,[2] Shields et al.,[3] and Golchet et al.[4] are based on the consistent location of the lesion. However, these hypotheses cannot explain the presence of double torpedoes, the second torpedo being away from the horizontal raphe, the site of the fetal bulge, and the emissary canal of the long posterior ciliary artery and nerve. OCT angiographic findings have pointed toward abnormalities of the choroidal vasculature, and the presence of double torpedoes seems to support this hypothesis.[5] Conclusion This is unique case of double torpedoes in torpedo maculopathy. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. ==== Refs 1 Paulose RM Torpedo maculopathy Kerala J Ophthalmol 2017 29 223 5 2 Pian D Ferrucci S Anderson SF Wu C Paramacular coloboma Optom Vis Sci 2003 80 556 63 12917574 3 Shields CL Guzman JM Shapiro MJ Fogel LE Shields JA Torpedo maculopathy at the site of the fetal “bulge” Arch Ophthalmol 2010 128 499 501 20385950 4 Golchet PR Jampol LM Mathura JR Jr Daily MJ Torpedo maculopathy Br J Ophthalmol 2010 94 302 6 19822914 5 Chawla R Pujari A Rakheja V Kumar A Torpedo maculopathy: A primary choroidal capillary abnormality? Indian J Ophthalmol 2018 66 328 9 29380796