case_images: PMC11060702_01
case_images: Initial presentation. a Fundus photograph of the left eye with macular pigmentary changes. b Optical coherence tomography of the optic nerve head showing diffuse thickening of the pigment epithelium and choroid. c Fluorescein angiography of the left eye within normal limits. d Late phase indocyanine green angiography of the left eye demonstrating washout effect.
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case_images: PMC11060702_01_cop-2024-0015-0001-535948_F01.jpg
case_images: F1
case_images: Fundus photographs of the left eye demonstrated fine pigmentary changes in the macula (shown in Fig. 1), and optical coherence tomography (OCT) of the left eye showed significant choroidal thickening (shown in Fig. 1b). Although fluorescein angiography seemed to reveal no pathologic findings (shown in Fig. 1c), indocyanine green angiography showed focal hyperfluorescent pooling in the macula, demonstrating a "wash out" phenomenon (shown in Fig. 1d).
case_images: Two years after initial presentation. a Fundus photograph of the left eye showing an elevated posterior pole with pigmentary changes in those areas. b Optical coherence tomography of the macula showing SRF, elongation of photoreceptor outer segments and precipitations over retinal pigment epithelium. c Fundus autofluorescence of the left eye showing hypo-autofluorescence of the central macula with mild ring of hyper-autofluorescence extending toward the inferior retina. d Ultrasound B-scan of left eye showing an echo-dense thickening of the choroid.
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case_images: PMC11060702_01_cop-2024-0015-0001-535948_F02.jpg
case_images: F2
case_images: Fig. 2a) and OCT of the left eye revealed new subretinal fluid (SRF) which had been first noted by the patient's ophthalmologist abroad 5 months prior (shown in Fig. 2b). Fundus autofluorescence demonstrated central hypo-autofluorescence with a hyper-autofluorescent ring around the macula that extended to the inferior retina (shown in Fig. 2c). B-scan ultrasonography showed an echo-dense lesion contiguous to the disc approximately 3.5 mm in maximum thickness and 14 mm in diameter with high to medium internal reflectivity (shown in Fig. 2d).
case_images: One-year post-treatment. a OCTm of the left eye showing decreased choroidal thickness with subretinal hyper-reflective materials and resorbed SRF. b Fundus photograph of left eye showing hypopigmentation in treated areas with hyperpigmentation and subretinal bands in the areas with PDT treatment overlap (demarcated in blue).
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case_images: PMC11060702_01_cop-2024-0015-0001-535948_F03.jpg
case_images: F3
case_images: At the 1-year follow-up appointment, BCVA had improved to 20/25, and OCT showed a dramatic decrease in choroidal thickness and flattening of elevated posterior pole curvature with no recurrence of SRF (shown in Fig. 3a). However, hypopigmentation was evident in the entire treatment area with subretinal pigment clumps most noticeable in the areas with 3 overlapping exposures of PDT (shown in Fig. 3b).