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Crora ASRS 2020

A 54-year-old healthy male presented to us with a decreased vision in right eye since past 8 years. The patient gave a history of bleed in right eye before 8 years for which some intravitreal injection was given; post which there no major visual improvement. No details or documentation was available regarding the same. His BCVA in the right eye was 5/60. Fundus examination revealed a sharply demarcated hypopigmented patch over the macula with mild posterior excavation suggestive of macular scar. OCT image shows foveal thinning with loss of Retinal pigment epithelium and outer retinal layers (RORA). There are 2 types of RORAs, complete and incomplete. Complete RORA and incomplete RORA are entities defined by various imaging modalities describing atrophy of the retinal pigment epithelial and the outer retinal layers. OCT imaging defines incomplete RORA (iRORA) as a region of signal hyper transmission into the choroid and a corresponding zone of attenuation ordisruption of the RPE (<250um) and evidence of overlying photoreceptor degeneration (<250um). There should not be any RPE tear associated with it. OCT imaging describes complete RORA (cRORA) based on 4 inclusion criteria. These include, area of hypertransmission of more than 250um, zone of attenuation or disruption of the RPE of more than 250um in diameter, evidence of overlying photoreceptor degeneration and absence of scrolled RPE or other signs of an RPE tear. Other modalities used to define these include fundus autoflourescence(FAF), near infrared reflectance(NIR) and color fundus photograph(CFP). On CFP, it shows a sharply demarcated hypopigmented of >250um size with better visibility of choroidal vessels. FAF shows a hypo autoflourescent patch with sharply demarcated borders of size

>250um, the colour of which is similar to that of the optic nerve head or retinal blood vessels excluding any pigmentation or artefact. On NIR, it shows a hyperreflective area with sharply demarcated borders of >250um size excluding any artefact. RORA can be seen in conditions like geographical atrophy in ARMD, central areolar choroidal dystrophy, atrophy secondary to anti-VEGF treatment.

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