PMC7748891_01
Initial examination of the right eye. Color fundus photo shows subretinal fluid (arrows) and elevated subretinal mass extending beyond the inferior arcade (a). Horizontal scans of optical coherence tomography (OCT) from the fovea to inferior vascular arcade shows subretinal fluid with a dome-shaped elevated choroidal mass in the macular area (b). Vertical scan of enhanced depth imaging optical coherence tomography shows a homogenous hyporeflective elevated lesion in the choroid (c). Ultrasonography shows a hyperechoic choroidal mass with medium to low internal reflectivity (d). Fluorescein angiography in the late phase shows the pooling of dye in the subretinal area and multiple hyperfluorescent dots over the lesion (e). Midphase indocyanine green angiography reveals multiple small, round, hypocyanescent dots in the posterior and midperipheral fundus (f).
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Funduscopy of the OS was normal and the OD was remarkable for a serous retinal detachment (SRD) and a 4 to 5-disc diameter submacular elevated mass with extension beyond the inferior arcade (Figure 1(a)). Spectral-domain optical coherence tomography (SD-OCT) confirmed a dome-shaped elevated choroidal mass with associated SRD (Figure 1(b)) OD. Enhanced depth OCT (EDI-OCT) of the OD demonstrated a homogenous hyporeflective elevated choroidal lesion, with compression of the choroidal vascular structures (Figure 1(c)). Ultrasonography confirmed a hyperechoic choroidal mass (Figure 1(d)). Early-phase fluorescein angiography (FA) showed pooling consistent with SRD and multiple hyperfluorescent dots over the mass with the persistence of these dots through late phases without disc leakage (Figure 1(e)). Indocyanine green angiography (ICGA) revealed diffuse and multiple foci of small, round, hypocyanescent dots in both early and late phases (Figure 1(f)).
Follow-up examinations. Optical coherence tomography two weeks after initial presentation showed improvement of subretinal fluid, decreasing the size of the choroidal mass, disruption of the ellipsoid zone, and accumulations of hyperreflective material of variable size and shape under the fovea (a) and the corresponding retina over the choroidal mass (b). Ultrasonography two weeks after the initial presentation revealed decreasing the size of choroidal mass (c). OCT one month after initial presentation showed near-complete resolution of choroidal mass and SRF, EZ restoration, and disappearance of hyperreflective materials over RPE and outer retina.
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Interestingly, there was disruption of the ellipsoid zone (EZ) and multifocal accumulation of hyperreflective material not previously seen on initial OCT (Figures 2(a) and 2(b)). Ultrasonography confirmed the decrease in the size of choroidal mass (Figure 2(c)). OCT and ultrasonography showed nearly complete resolution choroidal mass effect, SRD, and EZ disruption (Figure 2(d)).