A 19-year-old asymptomatic woman

To describe a case of stellate multiform amelanotic choroidopathy (SMACH) with focal hyperfluorescence on indocyanine green angiography (ICGA).

Case report.

A 19-year-old Caucasian woman was seen for an asymptomatic choroidal lesion. Visual acuity was 20/20. Fundus examination revealed an irregular, tan-colored lesion with overlying speckled hyperpigmentation in the macula of the left eye. Multimodal imaging demonstrated a thickened choroidal lesion with stellate, radially oriented projections most visible on near-infrared reflectance, red-free photography, en-face OCT, and ICGA. ICGA demonstrated early hypofluorescence outlining the borders of the lesion and a late, pinpoint area of hyperfluorescence with faint staining. The patient's fundus examination remained stable over 4 years of follow-up.

SMACH may present with focal choroidal hyperpermeability on ICGA while lacking typical features of central serous chorioretinopathy (CSCR). This finding expands the clinical spectrum of SMACH.