PMC8046551_01
Wide-field fundus photography of the right eye (A) shows an ovoid, hypopigmented placoid lesion adjacent to the fovea. FAF (B) reveals corresponding hypoautofluorescence and surrounding areas of hyperautofluorescence with irregular borders. Near-infrared reflectance (C) and spectral-domain optical coherence tomography (D) reveal speckled hyperreflectivity within the lesion and significant disruption of the outer retina, including the outer nuclear layer, ellipsoid zone, and retinal pigmented epithelium with choroidal hypertransmission. Early hyperfluorescence with FA (E) precedes increased hyperfluorescence of the macular lesion with discrete borders upon recirculation phase (F). Late-phase indocyanine green angiography shows multiple areas of hypocianescence in the right (G) greater than the left eye (H), including the area corresponding to the lesion. (b) Spectral-domain optical coherence tomography at 6 months after initial presentation shows improved attenuation in the outer plexiform layer.
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fig1
Fundus examination revealed an ovoid-shaped, tan, hypopigmented lesion just inferior to the fovea in the right eye (Figure 1). Late-phase indocyanine green angiography (ICG) showed multiple areas of hypocianescence corresponding to choroidal nonperfusion:worse on the right, but present in both eyes (Figure 1). Six months after initial presentation, patient's subjective complaints of a scotoma had resolved and SD-OCTA revealed improved perfusion of the choriocapillaris and choroid and OCT showed improvement in the attenuation of the ellipsoid zone (Figures 1(b) and 2).
Spectral domain-optical coherence tomography angiography findings at various levels during the 1-month and 6-month follow-up. An asterisk marks the center of the lesion. Normal perfusion is seen in the deep capillary plexus (DCP) of the right eye at 1 month (A) and at 6-month (B) follow-up, as well as in the left eye at 1 month (G) and 6 months (H). Perfusion deficit of the right eye is noted at the area of the lesion in the choriocapillaris (C) and choroid (E), with choroidal vascular dilatation (arrowhead). Similar areas of choriocapillaris (I) and choroidal (K) hypoperfusion is seen in the fellow eye. Improved perfusion is noted at 6-month follow-up in both eyes (D, F, J, L), with persistent choroidal vascular dilatation in the right eye (F, arrowhead).
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fig2
Notably, there was a vascular perfusion defect at the level of the choriocapillaris and choroid in the area corresponding to the lesion (Figure 2).