STELLATE MULTIFORM AMELANOTIC CHOROIDOPATHY: Clinical and Multimodal Imaging Features

Area of Science:

• Ophthalmology
• Medical Imaging

Background:

• Stellate multiform amelanotic choroidopathy (SMACH), previously termed serous maculopathy due to aspecific choroidopathy, is a rare ocular condition.
• Understanding its clinical and imaging characteristics is crucial for accurate diagnosis and management.

Purpose of the Study:

• To delineate the clinical presentation and multimodal imaging findings of SMACH.
• To evaluate the consistency of imaging features and propose a refined nomenclature.

Main Methods:

• A retrospective observational case series of 18 eyes from 18 patients diagnosed with SMACH.
• Multimodal imaging analysis including fundus photography, OCT, OCTA, and ICGA.

Main Results:

• Ophthalmoscopy revealed yellowish-orange, dendriform choroidal lesions in all cases.
• Subretinal fluid was present in 56% of cases at presentation, but absent in 44% during follow-up.
• OCT and OCTA showed inner choroidal hyperreflective changes with preserved choriocapillaris flow; ICGA demonstrated early and late hypofluorescence.

Conclusions:

• SMACH is a unilateral choroidopathy with distinct multimodal imaging signatures.
• The consistent dendriform pattern, irrespective of subretinal fluid, supports the proposed renaming to "stellate multiform amelanotic choroidopathy" to retain the SMACH abbreviation.