PMC5088474_01
Color fundus photograph of the left eye in a 25-year-old man with a combined hamartoma, with magnified insets and accompanying horizontal cross sectional spectral domain optical coherence tomography (SD-OCT) images. A subfoveal vitelliform lesion is noted (yellow arrow)
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Fig1
Dilated fundoscopy of the right eye was normal; fundoscopy of the left eye showed a slightly elevated greyish lesion with scattered pigmentary changes superior to the optic nerve which extended in a fan-like distribution from the optic nerve (Fig. 1). SD-OCT through the tumor showed thickening and disorganization of the inner and outer retina with marked saw-tooth like corrugations along the vitreoretinal interface (Fig. 1).
Multimodal imaging of the left eye of a 25-year-old man with a combined hamartoma and subfoveal vitelliform lesion. Fluorescein angiography shows distortion of the peripapillary vasculature while demonstrating the microcirculation within the hamartoma. Red-free imaging shows the extent of tangential traction with radial striae emanating from the tumor, which involves the fovea. Fundus autofluorescence shows speckled pattern of hypoautofluorescence due to the masking effect of the hamartoma. The subfoveal vitelliform lesion is intensely hyperautofluorescent
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Fig2
Fundus autofluorescence showed intense hyperautofluorescence from the vitelliform lesion as well as granular hypoautofluorescence inferotemporal to the lesion (Fig. 2). Early hyperfluorescence of the combined hamartoma was visible in fluorescein angiography along with an increased intrinsic vascularity within the lesion itself (Fig. 2). 
En-face optical coherence tomography angiography (OCTA) montage of the left eye of a 25 year old man with a combined hamartoma and subfoveal vitelliform lesion incorporating a 4.5 x 4.5 mm scan of the peripapillary area, a 6 x 6 mm scan of the macula, and a higher resolution 3 x 3 mm scan of the fovea. Segmentation of all scans includes the full thickness of the neurosensory retina. The flow signature corresponding with the small vessels of the hamartoma has a disorganized morphology. Tractional effects and distortion of the foveal avascular zone are also appreciated
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Fig3
OCTA revealed significant distortion of the retinal microcirculation intralesionally along the radial peripapillary capillary network superior and superotemporally to the optic nerve head with vessels appearing fine and tortuous in a corkscrew pattern (Fig. 3).