PMC5088475_01
Color photograph and fundus autofluorescence images of the posterior pole of the left eye show a rectangular area of mottled retinal pigment epithelial atrophy arranged with its long axis aligned horizontally.
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Fig1
Ophthalmoscopic examination showed peripapillary atrophy and retinal pigment epithelial changes that were consistent with myopic degeneration (Figure 1).
Topological representations of the posterior pole. Vertical and horizontal raster spectral domain optical coherence tomography line scans show that the long axis of the elliptical dome lies in the horizontal meridian, as demonstrated also by a quad-mesh projection onto an elevation-mapped near-infrared image plane. The region of atrophy lies at the inferior border of the crest of the elliptical dome, where the choroid is thinnest.
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Fig2
Heidelberg Engineering, Germany) raster scans did not overtly illustrate any dome configuration of the patient's macula. However, a combination of horizontal and vertical raster scans enabled a radially asymmetric three-dimensional dome-shaped configuration to be appreciated (Figure 2). A complex irregular pigment epithelial detachment was noted at the left macula consistent with a polypoidal lesion and its associated type 1 branching vascular network (BVN) (Figures 2, 3).
Multimodal imaging findings of choroidal neovascularization. Early and transit phase indocyanine green angiographic frames demonstrate perfusion of a choroidal vascular loop at the fovea (green arrowhead) followed by hyperfluorescence of at least three polypoidal lesions (red arrowheads) and their feeding network (yellow arrowhead). Magnified horizontal and vertical raster enhanced depth spectral domain optical coherence tomographic (OCT) line scans through these areas show the polypoidal lesions as peaked pigment epithelial detachments (PEDs) and the feeding network as an adjacent shallow irregular PED. The presence of pathologically dilated choroidal vessels is noted with overlying loss of choriocapillaris tissue, especially at the crest of the dome. En face OCT (3 x 3 mm) through the shallow PED reveals the spherical morphology of at least three polypoidal lesions. En face OCT angiography (3 x 3 mm) through the PED isolates the type 1 neovascular tissue from the rest of the choroid and shows significant flow through the feeder vessels and within the polypoidal lesions.
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Fig3
The vertically oriented OCT line scans showed an abrupt change in choroidal thickness occurring at the inferior edge of the dome (Figure 3). A complex irregular pigment epithelial detachment was noted at the left macula consistent with a polypoidal lesion and its associated type 1 branching vascular network (BVN) (Figures 2, 3). Topcon Corporation, Tokyo, Japan) and split spectrum amplitude decorrelation angiography (Avanti, Optovue, Fremont, CA, USA) demonstrated the polypoidal lesion and its corresponding feeding vessels (Figure 3). The ICGA also showed relatively larger caliber choroidal vessels in the thicker choroid at the superior edge of the dome.