PMC6280435_01
Color montage photographs and optical coherence tomography angiography. Color montage photograph of the right eye a shows an orange pigment epithelium detachment (PED) with a hemorrhage visible just above the superotemporal vascular arcade. Spectral-domain optical coherence tomography (SD-OCT) B-scan (b), obtained along the lesion as indicated by the yellow dashed line reveals retinal pigment epithelium (RPE) irregularities as indicated by white arrowheads. Optical coherence tomography angiography (OCTA) B-scan with angiographic flow overlay c shows flow signal within the PED. Color montage photograph of the left eye d shows a nasal PED. SD-OCT B-scan e along the dashed line demonstrates a peaked PED with a shallow irregular portion (white arrowheads). OCT B-scan with flow overlay f of the same area reveals flow signal beneath the RPE
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Fig1
Ophthalmoscopic examination of the right eye identified subretinal hemorrhage surrounding a pigment epithelial detachment (PED) located above the superotemporal vascular arcade (Fig. 1a). Spectral-domain optical coherence tomography (SD-OCT) demonstrated the presence of a PED accompanied by irregularities of the retinal pigment epithelium (RPE) profile (Fig. 1b). Optical coherence tomography (OCT) B-scan with angiographic flow overlay showed a peaked PED with intrinsic flow signal (Fig. 1c). Ophthalmoscopic examination of the left eye demonstrated a PED nasal to the optic nerve (Fig. 1d) characterized by a dome-shaped elevation of the RPE with a shallow irregular portion on SD-OCT (Fig. 1e), whereas the angiographic flow overlay revealed intrinsic flow signal (Fig. 1f).
Fundus autofluorescence and indocyanine green angiography. Fundus autofluorescence shows the presence of cuticular drusen scattered along the vascular arcades and in proximity to the lesion (white arrows) in both right (a) and left (b) eyes. Indocyanine green angiogram confirmed the presence of multiple hyperfluorescent nodular lesions (white arrowheads) with hypofluorescent halos in the right eye (c) and faint surrounding hyperfluorescence in the left eye (d)
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Fig2
Multiple, small, cuticular drusen appearing as small hypoautofluorescent dots on fundus autofluorescence (FAF) were seen in both eyes along the vascular arcades (Fig. 2a, b). Indocyanine green angiography (ICGA) showed focal areas of hyperfluorescence within the PEDs, indicative of AT1 (Fig. 2c, d).  
Optical coherence tomography angiography (OCTA) with the right eye represented by the right column (a, c, e) and the left eye by the left column (b, d, f). The structural slabs a, b of the lesions in both eyes were obtained using an RPE-RPE fit segmentation. En face OCTA with customized segmentation between RPE and Bruch's membrane shows a type 1 neovascular network with evident aneurysmal dilatation, as demarcated by the crossing blue and green lines (c, d). Dense B-scan with angiographic flow overlay e, f demonstrates the corresponding cross-sectional view and the customized segmentation of the respective lesions
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Fig3
OCT angiography en face slab demonstrated aneurysmal dilatation arising from a type 1 neovascular network, particularly evident in the right eye (Fig. 3a, c, e) with active lesions.