We were confident that our patient had nothing more than classic bear tracks. More specifically, such lesions are not round like most CHRPE, but more oval––almost exhibiting a football shape. 1,3 However, the shape of the CHRPE lesions seen in these patients is uniquely different than what is seen in patients with either classic CHRPE formation or bear tracks. The risk for intestinal malignancy in adults with Gardner’s syndrome is virtually 100%. Gardner’s syndrome, also known as familial colorectal polyposis, is an autosomal dominant disease that is characterized by adenomatous polyposis of the large and small intestines, hamartomas of the skeleton and various soft tissue tumefactions. The presence of multiple CHRPE lesions in both eyes should raise a concern for Gardner’s syndrome. In addition, when examined å electron microscopy, hypertrophy and hyperplasia of the RPE cells is not a significant feature in patients with bear tracks. For instance, bear tracks are more elliptical in shape than CHRPE. 2 However, there are ultrastructural differences between the two entities. In fact, it has been suggested that CHRPE and bear tracks are different expressions of the same condition. There has been some debate regarding the differences between CHRPE and bear tracks, because both presentations have a similar histopathology. The bear tracks are significantly more apparent on fundus autofluorescence, where the hyperpigmentation causes evident blockages. In our patient, they were predominantly located in the nasal retina, inferiorly in the right eye and superiorly in the left. They are often grouped in one sector of the fundus. For that reason, these lesions have been referred to as “bear tracks.”īear tracks are congenital anomalies that are characterized by small, sharply circumscribed, variably sized, pigment spots. In fact, if you use a little imagination, you almost get the impression that the pigmented lesions look like the paw prints of an animal that has been walking around the retina. ![]() One particularly interesting CHRPE variation presents as clusters or groups of lesions, as seen in our patient. Fundus autofluorescence reveals the presence of multiple pigmented lesions (O.D. However, there are variations in how CHRPE may present.ģ, 4. 1,2 Its color can vary from dark brown or black to gray, and lacunae can be present within the lesion.ĬHRPE are benign lesions that are usually discovered as an incidental finding during a routine eye exam. A typical CHRPE is a solitary, round, flat, well demarcated, hyperpigmented lesion that is present at birth. The multiple lesions seen in both eyes represent a form of CHRPE. What is the significance of these lesions? Note the peculiar lesions scattered throughout the retinae.Ģ. Congenital hypertrophy of the retinal pigment epithelium (CHRPE).ġ, 2. What are the peculiar fundus lesions seen in both eyes?ī. Additionally, we performed fundus autofluorescence ( figures 3 and 4).ġ. We noted multiple, peculiar lesions in each eye ( figures 1 and 2). The vessels were of normal caliber and the maculae appeared normal. His intraocular pressure measured 13mm Hg O.U.ĭilated fundus exam showed clear vitreous without cells, as well as moderate-sized cups with good rim coloration and perfusion O.U. The anterior segment examination was unremarkable. His pupils were equally round and reactive to light, with no afferent defect. Confrontation visual fields were full to careful finger counting O.U. With hyperopic correction, he was able to see 20/20 O.U. On examination, his uncorrected visual acuity measured 20/200 O.D. ![]() He took several medications, including Isentres (raltegravir, Merck), Prezista (darunavir, Janssen Therapeutics), Norvir (ritonavir, Abbott), PhenaTrim (weight loss supplement), acyclovir and lisinopril. He did not know his CD4 number or his viral load, but indicated that he saw his doctor every three months. Additionally, he reported hypertension and borderline high cholesterol. His medical history was significant for HIV, which was diagnosed in 1992. The patient said that the glasses helped, but he still struggled to see. He reported that he only wore +2.00D over-the-counter reading glasses. A 55-year-old black male presented with complaints of blurred vision at both distance and near.
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