case_images: PMC9149162_01
case_images: (A) Widefield color fundus photograph of the right eye revealed a large optic disc centrally covered with glial tissue and encircled with chorioretinal pigmentary disturbance, as well as straight retinal vessels radially issuing from the disc margin with increased numbers. (B) Spectral-domain optical coherence tomography (SD-OCT) revealed the conical excavation of the optic disc (yellow star) with a central tuft of glial tissue on top (white arrow).
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case_images: PMC9149162_01_fmed-09-826860-g0001.jpg
case_images: F1
case_images: A widefield color fundus image of the right eye revealed a large optic disc covered with glial tissue in the center and bordered by chorioretinal pigmentary disturbance, as well as straight retinal vessels extending radially from the disc margin in increased numbers (Figure 1A). The spectral-domain optical coherence tomography (SD-OCT) showed a conical excavation of the optic disc with a central tuft of the glial tissue on top (Figure 1B).
case_images: Computerized tomography scan of the orbit demonstrated a hyperdense choroidal plaque with the same density as bone at the level of the optic disc in the right eye.
case_images: fmed-09-826860-g0002.jpg
case_images: PMC9149162_01_fmed-09-826860-g0002.jpg
case_images: F2
case_images: However, the CT scan of the orbit demonstrated a hyperdense choroidal plaque with the same density as bone at the level of the optic disc in the right eye (Figure 2).
case_images: (A) B-scan ultrasonography demonstrated a highly reflected mass covering the optic disc, and a high echo spike originating from the surface of the lesion was detected on the combined A-scan. (B) Fundus photography showed a yellowish-white lesion around the optic disc (white arrow) and mottling of the retinal pigment epithelium (RPE) (yellow stars). (C) On enhanced depth imaging OCT (EDI-OCT), a well-defined peripapillary choroidal lesion with hyperreflective lamellar lines in the inner part and spongiform pattern in the outer part were depicted. (D) The late phase of FA revealed diffuse late staining around the optic disc and punctate hypofluorescence inferiorly. (E) The indocyanine green angiography (ICGA) illustrated early hypofluorescence and diffuse late staining in the juxtapapillary area. In the early phase, the patterns of vessels were obtained supranasally to the optic disc (red arrow). (F) The blood flow signals were demonstrated among the lesion on OCT angiography (OCTA).
case_images: fmed-09-826860-g0003.jpg
case_images: PMC9149162_01_fmed-09-826860-g0003.jpg
case_images: F3
case_images: The b-scan ultrasonography revealed a highly reflected mass covering the optic disc detected at even a very low gain, whereas the vector scan showed a high echo spike originating from the surface of the lesion (Figure 3A). On dilated funduscopic examination, a yellowish-white and slightly elevated lesion around the optic disc was detected, which had previously been considered a common annulus of chorioretinal pigmentary changes in MGD (Figure 3B). The enhanced depth imaging (EDI-OCT) image depicted a well-defined peripapillary choroidal lesion with hyperreflective lamellar lines in the inner part and spongiform pattern in the outer part, which replaced the normal choriocapillaris (Figure 3C). The fluorescein angiography (FA) showed early patchy hyperfluorescence and diffuse late staining around the optic disc (Figure 3D). It was noteworthy that during the early stages of ICGA, supranasal to the optic disc, the vascular patterns were obtained (Figure 3E), and the 6 x 6 mm OCT angiography (OCTA) centered at these locations delineated clusters of linear vessels on en face visualization. Additionally, a cross-sectional OCTA b-scan indicated blood flow signals in these lamellar choroidal lesions (Figure 3F). The mottling of the RPE around the optic disc was detected on the fundus imaging of the right eye (Figure 3A). Additionally, by reviewing the FA pictures of the right eye, the punctate hypofluorescence in the inferior region of the optic disc was discovered (Figure 3D).