A 19-year-old asymptomatic woman.

Area of Science:

• Ophthalmology
• Medical Imaging
• Choroidal Diseases

Background:

• Stellate multiform amelanotic choroidopathy (SMACH) is a rare condition affecting the choroid.
• Understanding its imaging characteristics is vital for accurate diagnosis.

Purpose of the Study:

• To document a case of SMACH presenting with specific findings on indocyanine green angiography (ICGA).
• To highlight focal hyperfluorescence as a potential sign of SMACH.

Main Methods:

• A case report detailing a 19-year-old woman with an asymptomatic choroidal lesion.
• Utilized multimodal imaging, including ICGA, near-infrared reflectance, red-free photography, and en-face OCT.

Main Results:

• The choroidal lesion exhibited stellate, radially oriented projections.
• ICGA revealed initial hypofluorescence at the borders and a late, pinpoint hyperfluorescence with faint staining.
• The lesion remained stable over a 4-year follow-up period.

Conclusions:

• SMACH can manifest with focal choroidal hyperpermeability on ICGA.
• This presentation differs from typical central serous chorioretinopathy (CSCR) findings.
• The study broadens the recognized clinical spectrum of SMACH.