Angiographic dark choroid in systemic non-hereditary amyloidosis

To describe a novel finding of angiographic dark choroid in a patient with systemic non-hereditary amyloidosis.

A 43-year old female with systemic light-chain amyloidosis associated with advanced kidney disease presented with metamorphopsia and blurry vision in both eyes of 1 year duration. Examination revealed subretinal yellowish deposits in the central macula and mid-periphery with patchy RPE mottling bilaterally. OCT demonstrated thickened choroid with a widened hyporeflective sub-Bruch's choriocapillaris band. FAF showed hypoautofluorescence of the central maculae with hyperautofluorescence flecks perifoveally. Fluorescein angiography demonstrated normal vascular filling without leakage and peripheral microaneurysms. The FA also revealed a strikingly diminished diffuse lack of choroidal fluorescence throughout all angiographic phases in both eyes which has not been previously described in this condition.

This case demonstrates that patients with systemic amyloidosis may exhibit attenuation of choroidal signal ("dark choroid") on fluorescein angiography, possibly due to accumulation of amyloid material in the sub-RPE space.