Cotton wool spot or something else? An inner retinal lesion in context
A 65-year-old man with tuberous sclerosis complex is referred after an optometrist finds a striking hyperreflective inner retinal lesion on OCT with nothing visible on fundoscopy. The differential includes cotton wool spots given his diabetes, hypertension, and renal transplant - but the history, bilateral involvement, and stability on serial photographs point firmly to retinal astrocytic hamartomas.
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