PMC6354168_01
Fundus autofluorescence (FAF) right eye at baseline. Note the laser scars appears as heterogeneous hypoAF foci in the temporal fundus of the right eye. Nasal to these, in the temporal macula, note the curvilinear group of faint hyperAF foci (black arrows).
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fig1
Spectral domain-OCT images of right macula from baseline (a) through follow-up at various intervals: +4 months (b), +7 months (c), +8 months (d), and +9 months (e). Note the waxing and waning of subretinal fluid, the variations in the appearance of the temporal pigment epithelial detachments, and the fovea remaining dry throughout follow-up.
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fig2
At review, repeat imaging revealed progression, though the fovea remained dry (Figure 2). Over the course of follow-up (9 months), the subfoveal space and vision were not affected (Figure 2).
Fundus fluorescein angiogram (55 ) of right eye (a, b) and left eye (e). Indocyanine green angiography (ICGA) of right eye (55  c, 30  d) and left eye (f). The branching vascular network (BVN, white arrows) and terminal hyperfluorescent polyps (white arrowheads) were clearly visible on ICGA. These also demonstrated a characteristic hypofluorescent halo. Note that the BVN originates from a hypofluorescent laser scar (* in c and d). FFA of the right eye revealed macular ischaemia. FFA and ICGA of the left eye were normal.
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fig3
PCV, Figure 3).
Fundus fluorescein angiogram of the right eye carried out 4 years before development of polypoidal lesions. Macular ischaemia is evident, together with active retinal neovascularization in the infero-temporal macula (red arrow). Previous laser retinal scars are also visible temporally.
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fig4
FFA (Figure 4, Topcon Corp, Tokyo, Japan) performed 4 years previously revealed macular ischemia, active retinal neovascularization and previous laser therapy, however there was no evidence of PCV on that angiogram.
Infra-red image (a) of right eye with corresponding enhanced depth-imaging (EDI) spectral domain-OCT of right macula at the 9 months follow-up time-point. The black dashed line indicates to relevant position of the EDI images (upper b, lower c). Note the "double-layer" sign in image (c) (white arrow) as a hyper-reflective area in the space between the retinal pigment epithelium and Bruch's membrane. This suggests the location of the branching vascular network. Within the pigment epithelial detachments, hyper-reflective lesions can be seen that most likely represent polyps (white arrow-head in b, c).
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fig5
OCT revealed with the 'double-layer' sign and polyps within the temporal macular PEDs (Figure 5). OCT-Angiography images (Zeiss Angioplex) demonstrated widespread macular ischaemia in the right macula, together with the BVN and polyps (Figure 6).
OCT-Angiography (OCT-A) images of the right eye at the 7-month follow-up time-point. The superficial (a) and deep (b) OCT-A slabs revealed macular ischaemia. The polyps were visible in (b), the avascular (c) and choriocapillaris (d) slabs. Flow within the polyps was seen on the cross-sectional OCT-A image (e).
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fig6
OCT revealed with the 'double-layer' sign and polyps within the temporal macular PEDs (Figure 5). OCT-Angiography images (Zeiss Angioplex) demonstrated widespread macular ischaemia in the right macula, together with the BVN and polyps (Figure 6).