PMC9082210_01
Color fundus photograph, near-infrared image, and ICGA. a Color photograph shows a serpiginous lesion: ampulla inferior to fovea and extending temporally toward the equator. b Near-infrared image showing hyper- and hyporeflective spots along the lesion. c ICGA early phase shows rapid filling of a large branching lesion. d ICGA late phase with no leakage from the lesion.
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F1
The right eye examination was notable for an orange-red, serpentine, track-like lesion inferior to the fovea that extended temporally to the equator, with associated overlying retinal pigment epithelium changes (Fig. 1a). Near-infrared image showed hyper- and hyporeflective spots along the lesion (Fig. 1b). ICGA demonstrated filling of the large branching lesion in the early phase suggesting an arterial origin (Fig. 1c) and the lack of leakage in the late phase (Fig. 1d) ruled out choroidal inflammation.
EDI-OCT and SS-OCTA. a Hyporeflective lesion with posterior shadowing. b Magnified scan showed scattered disruptions of the Bruch's/RPE complex with hyper-reflective foci in the outer retina. c En face OCTA scan showed a large tortuous vessel with a similar signal as adjacent physiological choroidal vessels (the dark signals are consistent with fringe washout artifact). d Customized slab through the entire thickness of the choroid. EDI-OCT, enhanced depth imaging optical coherence tomography; RPE, retinal pigment epithelium.
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F2
Enhanced depth imaging OCT through the lesion demonstrated its origin in the choroid-scleral junction elevating overlying retina (Fig. 2a) with scattered disruption of the Bruch's/retinal pigment epithelium complex and few hyper-reflective foci in the outer retina (Fig. 2b). En face SS-OCTA (DRI OCT Triton; Topcon, Tokyo, Japan) imaging (Fig. 2c) with a custom slab through the entire thickness of the choroid (Fig. 2d) showed a large tortuous lesion with a similar signal as adjacent physiological choroidal vessels indicating similar flow velocity.