Multimodal imaging of a choroidal macrovessel

Purpose To describe the features of a choroidal macrovessel (CM) in multimodal imaging and underline the importance of non‐invasive imaging techniques. Methods A 78‐year‐old man presented to our department for alteration of central vision of the right eye after uneventful cataract surgery. The patient had a complete ophthalmic examination with best corrected visual acuity (BCVA) measurement and slit lamp examination. Multimodal imaging was performed including fundus autofluorescence (FAF), Swept‐Source Optical Coherence Tomography (SS‐OCT), en‐face OCT, OCT‐angiography, Fluorescein Angiography (FA) and Indocyanine Angiography (ICG‐A). Results BCVA was 20/50 in the right eye and 20/80 in the left eye. Anterior segment examination was unremarkable except for a nuclear cataract in the left eye. Funduscopic examination showed a subretinal tortuous lesion starting in the fovea and extending toward the temporal periphery in the right eye and was normal in the left eye. FAF of the right eye showed increased autofluorescence of the lesion retracing its serpiginous shape. SS‐OCT revealed a choroidal hollowness. This lesion had a pattern corresponding to a choroidal macrovessel on en‐face OCT scans with a similar signal to the physiological choroidal vessels. OCT‐A showed a low signal within the choroidal vessel. FA of the right eye showed an early serpentine‐shaped hyperfluorescence and ICG‐A revealed early prominent filling with late hypofluorescence and persisting laminar flow. A choroidal macrovessel (CM) was diagnosed. Conclusions CM is a rare entity that is not always easy to recognize. ICGA is the most valuable tool for its diagnosis when the presentation is not typical. In cases of CM with a well delineated pattern, non‐invasive imaging modalities and particularly SS‐OCT and en‐face OCT can be very helpful for the diagnosis while avoiding dye injection.