Enhanced Depth Imaging Features of a Choroidal Macrovessel

Abstract

Purpose To report a case of a choroidal macrovessel imaged using enhanced-depth imaging spectral domain optical coherence tomorgraphy (EDI SD-OCT) and describe the choroidal features. Methods Case report. A 42-year-old man presented with metamorphopsia. Multimodal imaging, including color fundus photography, near infrared reflectance (NIR), and EDI-OCT was used to describe a choroidal macrovessel. Results Initial ophthalmic examination revealed a serpentine-shaped subretinal pattern deep to the retina near the fovea. When the color image was subjected to a red-filter, a large diameter vessel could be seen coursing from the fovea to the temporal macula. EDI-OCT of the choroidal macrovessel revealed a thickened choroid, and mild deformation of both the ellipsoid zone and the choroidal-scleral junction. En face SD-OCT at the level of the choroid demonstrated the anomalous vessel. Conclusions EDI-OCT and en face OCT, used in conjunction with other imaging modalities, can be used to demonstrate the presence and pattern of a choroidal macrovessel. A thickened choroid and overlying outer retinal indentation was observed in association of the choroidal macrovessel. These imaging tools can help distinguish this condition from other diagnoses with a similar appearance, such as ophthalmomyiasis.

Non-invasive imaging of a choroidal macrovessel

“…The track-like nature of these lesions with accompanying retinal RPE changes can lead to confusion with parasitic tracks, such as ophthalmomyiasis, choroidal vascular neoplasms, retinochoroidal anastomosis and inflammatory choroidopathies, among others. 3 …”

“…Choroidal macrovessels seem to be lesions that remain unnoticed because of their asymptomatic, subtle clinical findings, although metamorphopsia and blurry vision have been reported in four cases. 2 , 3 , 4 , 5 When visual symptoms are present, they could be explained by a spectrum of clinical presentations, which range from mild EZ and RPE changes 3 to mounding and hyperpigmentation of the RPE, debris, subretinal fluid (SRF), and changes in the outer nuclear layer thickness. 6 Although observation is the treatment of choice, other options might be considered when subretinal fluid is present in the fovea.…”

“…Although invasive tests have been widely used, non-invasive imaging tools can be used as well to describe the features of this condition as reported in three previous cases. 3 , 8 , 9 …”

New Landmarks, Signs, and Findings in Optical Coherence Tomography

“…Choroidal macrovessel is not associated with acute inflammation and symptoms. Some reports have shown hyperpigmentation of the RPE, debris in the subretinal space, and changes in the outer nuclear layer (ONL) thickness [82,83]. SD-OCT reveals a tubular structure which shows hyperreflectivity band below RPE representing the superior edge of the lesion, with an elevation of RPE and photoreceptor and posterior shadowing [81].…”

“…SD-OCT reveals a tubular structure which shows hyperreflectivity band below RPE representing the superior edge of the lesion, with an elevation of RPE and photoreceptor and posterior shadowing [81]. In recent studies, it has been explored with enhanced-depth imaging spectral domain optical coherence tomography (EDI SD-OCT) showing a vascular structure that traversed the entire choroidal thickness and produces an indentation at the choroidal-scleral junction and the ellipsoid zone (EZ) causing a reduction of the ONL thickness [82,83]. A differential diagnosis from choroidal macrovessel should be made with subretinal nematode tract, choroidal hemangioma, inflammatory choroidopathy, retinochoroidal anastomosis, vortex varix, and aberrant long posterior ciliary artery [81,83].…”