PMC5015607_01
Three days after the event, the left fovea is abnormal with yellowish swelling and a supramacular hemorrhage (top right). The early fluorescein angiogram shows normal perfusion and no window defects (top right). Midphase (bottom left) and late angiogram (bottom right) show no leakage and are normal.
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F1
Three days after the event with the flash light, VA was 20/70 and an acute light-induced maculopathy was noted in the LE with a suprafoveal retinal hemorrhage and a yellow swollen aspect of the fovea (Figure 1 (Fig. 1)).
OCT imaging with horizontal section of the left macula 3 days (top) and 6 days (bottom) after the event. Note the hyperreflective foveal lesion, initially prominent, and reduced 3 days later with at that time also regression of the hemorrhage to half size.
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F2
OCT imaging was normal for the right eye and showed in the left eye a macular lesion with increased reflectivity of the RPE and the overlying retina (Figure 2 (Fig. 2)).
Six days after the event the ICG angiogram shows in the early phase (top right) focal choroidal non perfusion in the papillomacular and macular area, compatible with delayed filling in a watershed zone. In midphase and late phase ICG angiogram (bottom left and right) no anomalies are noted.
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F3
The indocyanine green angiography (ICGA) showed early deep papillomacular and macular hypofluorescence compatible with a watershed zone, and there were no anomalies in the mid and late phase of the angiogram (Figure 3 (Fig. 3)). 
Four weeks after the event the left macula shows pigmentary changes, and is definitely different from the normal right macula.
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F4
The right posterior pole was normal (Figure 4 (Fig. 4)) and a macular scar was observed in the left eye.
The OCT imaging with a horizontal section of the macula is normal in the right eye and shows in the left eye a small deep foveal lesion. Moreover, the central macular thickness is mildly reduced in the left eye (245 micron RE, 236 micron LE).
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F5
OCT showed in the left eye a further reduction of the deep macular lesion and the central macular thickness was 236 micron (Figure 5 (Fig. 5)).
The autofluorescence imaging shows in the right eye a normal hypofluorescent macula compatible with normal macular pigment and normal subfoveal RPE. The left macula is different with less hypofluorescent compatible with loss of macular pigment and/or RPE damage.
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F6
Autofluorescence imaging of the right macula was normal and was different in the left eye with a less hypofluorescent macula compatible with loss of macular pigment and/or RPE damage (Figure 6 (Fig. 6)). 