STELLATE MULTIFORM AMELANOTIC CHOROIDOPATHY: Clinical and Multimodal Imaging Features

Prithvi Ramtohul, Marco Pellegrini, Francesco Pichi, Chiara Preziosa, Alessandro Marchese, Maria Vittoria Cicinelli, Elisabetta Miserocchi, Rusdeep Mundae, Sarah Mrejen, Soraya Rofagha, Calvin E. Mein, Luke Mein, Michael D. Ober, Eduardo Cunha de Souza, Salomon Yves Cohen, Elon H. C. van Dijk, Lee Jampol, Camiel J. F. Boon, K. Bailey Freund

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Abstract

PURPOSE: To describe the clinical and multimodal imaging features of stellate multiform amelanotic choroidopathy (SMACH; also known as serous maculopathy due to aspecific choroidopathy). METHODS: Retrospective observational case series of eyes presenting with SMACH. Multimodal imaging including fundus photography, optical coherence tomography (OCT), OCT angiography (OCTA), and indocyanine green angiography (ICGA) was analyzed. RESULTS: Eighteen eyes from 18 patients (mean age: 28 ± 19 years) were included. The mean follow-up duration was 9 years. Ophthalmoscopy showed a yellowish orange, dendriform choroidal lesion. At presentation, subretinal fluid (SRF) was seen in 10 of 18 cases (56%). Eight patients (44%) showed no evidence of SRF during a mean follow-up of 6 years. Cross-sectional OCT showed hyperreflective fibrous-like changes within the inner choroid with choriocapillaris flow preservation on OCTA. En face OCT showed a hyperreflective choroidal lesion with finger-like projections oriented in a stellate configuration. On ICGA, SMACH showed early and late hypofluorescence. None of the cases showed lesion growth. CONCLUSION: SMACH seems to be a unilateral choroidopathy characterized by distinctive multimodal imaging features. As SRF was absent in some cases, while a dendriform pattern was a consistent finding in all eyes, the authors propose renaming this entity "stellate multiform amelanotic choroidopathy," a name that retains its previous abbreviation "SMACH."
Original languageEnglish
Pages (from-to)1448-1461
Number of pages14
JournalRetina (Philadelphia, Pa.)
Volume43
Issue number9
DOIs
Publication statusPublished - 1 Sept 2023

Keywords

  • SMACH
  • multimodal imaging
  • optical coherence tomography
  • stellate multiform amelanotic choroidopathy

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