Case report

A 42-year-old white man presented for a routine evaluation. The patient had a history of travelling through developing countries. There was no history of trauma. Best corrected visual acuity was 20/20 in the right eye and 20/100 in the left eye. Dilated fundus examination of the right eye revealed a serpiginoid atrophic lesion in the temporal macula and multifocal chorioretinitic spots without any sign of acute inflammation. The lesion extended from the temporal paramacular area to the temporal periphery (figure 1). An optic nerve coloboma was observed in the left eye accounting for its diminished vision.

Fluorescein angiography (FA) of the right eye demonstrated normal filling and laminar flow in the both retinal arteries and veins. The filling pattern of the choroidal vessels, including the suspected lesion, was normal and occurred before the perfusion of the retinal vasculature. The lesion was hyperfluorescent consistent with perfusion of a choroidal vessel. No evidence of arteriovenous anastomosis, capillary nonperfusion, or late leakage was detected. Indocyanine green angiography (ICG) showed perfusion of the lesion with the ICG dye and hypofluorescence of the presumed vascular abnormality in the late phase of the exam (figure 2).