PMC5088479_01
Color photograph of patient's right eye showing a superior iris melanocytic lesion (a). Higher magnification view of the iris lesion displaying the pigmented mass with some associated vascularity (b)
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Fig1
The anterior segment examination was remarkable for a pigmented, vascularized iris mass lesion at the superior pupillary border in her right eye (Fig. 1).
Standard flood-illuminated and Ultra-wide field (UWF) color photographs show multiple scattered melanocytic lesions throughout the fundus associated with pigmentary changes extending from the posterior pole (a, b). UWF AF shows round-like patches of hypo-AF alternating with intervening areas of hyper-AF in the posterior pole (c). ICG angiography shows these scattered melanocytic lesions to be hypofluorescent (d)
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Fig2
TRC-50XF; Topcon Medical Systems, Oakland, NJ) showed bilateral exudative macular detachments with multiple scattered darkly pigmented choroidal lesions (Fig. 2a). The extent of the pathology was better seen with ultra-widefield color images (Optos 200Tx; Optos, Scotland, United Kingdom) (Fig. 2b). Ultra-widefield autofluorescence (AF) imaging (Optos 200Tx; Optos, Scotland, United Kingdom) highlighted and documented the full extent of this pattern with patches of hypo-AF alternating with intervening areas of hyper-AF (Fig. 2c). Fundus camera based ICGA (Topcon TRC-50XF; Topcon Medical Systems, Oakland, NJ) showed the scattered darkly pigmented choroidal lesions as well-circumscribed hypofluorescent areas (Fig. 2d).  
Spectral-domain optical coherence tomography (SD-OCT) with matching near-infrared reflectance (nIR) localizes these discrete lesions to the choroid with compression of the choriocapillaris (red arrow) and associated subretinal fluid (blue arrow). The choroidal lesions are intensely hyper-reflective on nIR images (a-c). EDI-OCT shows markedly increased choroidal thickness with overlying subretinal fluid of the right (d) and left eyes (e)
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Fig3
The choroidal lesions were highly reflective on near-infrared reflectance (nIR) (Fig. 3a-c). Spectralis showed diffuse choroidal thickening beneath the exudative macular detachments (Fig. 3d, e). Swept-source OCT (DRI OCT-1; Topcon Medical Systems, Oakland, NJ) of the right eye showed alternating RPE thickening and RPE loss that corresponded to the appearance of the "giraffe-pattern" seen on the AF (Fig. 4).  
Swept-source optical coherence tomography (SS-OCT) through the fovea (a) and through a superior large melanocytic lesion (b) of the right eye highlighting the increased choroidal thickness, subretinal fluid and the alternating RPE thickening (red arrow) and RPE loss (yellow arrow) that corresponds to the appearance of the alternating pattern seen on the UWF AF
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Fig4
Spectralis showed diffuse choroidal thickening beneath the exudative macular detachments (Fig. 3d, e). Swept-source OCT (DRI OCT-1; Topcon Medical Systems, Oakland, NJ) of the right eye showed alternating RPE thickening and RPE loss that corresponded to the appearance of the "giraffe-pattern" seen on the AF (Fig. 4).  