case_images: PMC11372403_01
case_images: Multimodal imaging of a case of unilateral acute idiopathic maculopathy associated with hand, foot, and mouth disease. (a) Multicolor image of the right eye (OD) shows a circular area of grey-white dome-shaped dehiscent lesion at the center of macula. (b) Multicolor OCT image of the left eye (OS) is unremarkable. (c) FAF reveals hypoautofluorescence corresponding to dehiscence in OD. (d) FAF is normal in OS. (e) SD-OCT of OD shows bacillary detachment associated with and subretinal and pigment epithelium detachment along with intraretinal cysts and disruption of ellipsoid and interdigitation zone. (f) SD-OCT of OS is normal. (g) Optical coherence tomography angiography (OCTA) of OD demonstrates decrease choriocapillaris perfusion along with dilatation of vessels corresponding to the lesion and unremarkable in OS (h).
case_images: BEJ-9-165-g001.jpg
case_images: PMC11372403_01_BEJ-9-165-g001.jpg
case_images: F1
case_images: The multimodal imaging features of the baseline visit are shown in Figure 1. Multicolor imaging revealed dehiscence of foveal reflex and discoloration at the macula suggestive of serous retinal detachment in OD (Fig. 1a) and was normal in OS (Fig. 1b). Fundus autofluorescence (FAF) of OD showed hypoautofluorescence corresponding to serous detachment in multicolor image (Fig. 1c). FAF was normal in OS (Fig. 1d). OD (Fig. 1e), there was also disruption of ellipsoid and interdigitation zone. SD-OCT was unremarkable in OS (Fig. 1f). Optical coherence tomography angiography (OCTA) (Optovue, Inc.) showed decreased choriocapillaris perfusion along with dilatation of vessels corresponding to the lesion in OD, whereas superficial and deep plexus were normal (Fig. 1g). No significant finding was found on the OCTA of OS(Fig. 1h).
case_images: Fundus fluorescein angiography (FA) and ICG of a case of unilateral acute idiopathic maculopathy associated with hand, foot, and mouth disease at diagnosis. A1, A2, A3, and A4 show the early, mid, late, and 10th minute phases of FA, respectively. B1, B2, B3, and B4 indicate the early, early mid, late mid, and late stages of ICG, respectively. FA shows staining due to leakage in the early (A1) and mid-phase (A2) and pooling due to subretinal fluid in the late phase (A3 and A4), and ICG revealed hypocyanescence in early, mid and late phases (B1, B2, B3, and B4) in OD. FA and ICG of his left eye were unremarkable. Hypofluorescence in the upper vascular arcade was considered an artifact on his left eye.
case_images: BEJ-9-165-g002.jpg
case_images: PMC11372403_01_BEJ-9-165-g002.jpg
case_images: F2
case_images: FA and ICG of OS were unremarkable (Fig. 2).
case_images: Follow-up investigations after 2 months. (a) SD-OCT Multicolor image demonstrates irregular hyperpigmented fovea surrounded by elevated ring-like hypopigmentation in the parafoveal region. (b) FAF illustrates mixed hyper and hypo fluorescent area, mostly the stippled hyperfluorescent area at the rim of the lesion with irregular margin. (c) SD-OCT reveals highly reflective subretinal material at the macula with some recovery of ellipsoid and interdigitation zone along with thinning of outer retina. (d) SD-OCTA taken at the level of choriocapillaris segmentation line shows dark pattern at the center, indicating flow deficits in that area.
case_images: BEJ-9-165-g003.jpg
case_images: PMC11372403_01_BEJ-9-165-g003.jpg
case_images: F3
case_images: Multicolor image of OD demonstrated irregular hyperpigmented fovea surrounded by ring-like hypopigmentation in the parafoveal region (Fig. 3a). FAF revealed mixed hyper and hypoautofluorescent area, mostly the stippled hyperautofluorescent area at the rim of the lesion with irregular margin (Fig. 3b). SD-OCT showed hyperreflective subretinal material at the macula with some recovery of ellipsoid and interdigitation zone along with thinning of the outer retina (Fig. 3c). OCTA taken at the level of choriocapillaris segmentation line showed a dark pattern at the center indicating flow deficits (Fig. 3d), though there was a significant improvement in the blood flow to choriocapillaris as compared to baseline OCTA, but the resolution was not complete showing that the choroidal blood supply was not completely restored.
case_images: Measurement of measure of flow in choriocapillaris in right (OD) and left eye (OS). (a) Shows flow area of 3.39 mm2 in the selected area of 6.05 mm2 at the presentation in OD. (b) Shows flow area of 3.66 mm2 in the selected area of 6.02 mm2 in OD after 5 days. (c) Shows flow area of 3.98 mm2 in the selected area of 6.01 mm2 in OD after 2 months. (d) Shows flow area of 4.37 mm2 in the selected area of 6.0 mm2 in OS at 2-month visit.
case_images: BEJ-9-165-g004.jpg
case_images: PMC11372403_01_BEJ-9-165-g004.jpg
case_images: F4
case_images: There is a 22% flow gap at presentation, which reduced to 16% flow gap at 5 days of presentation, and a 7% flow gap at 2 months (Fig. 4).