Color fundus photograph shows numerous small white spots scattered in the posterior pole
Fig. 5.2
Fundus photograph shows no white spots (a) but fine granularity of the fovea (b)
Fig. 5.3
Late phase indocyanine green angiography (a) of Fig. 5.1 case demonstrates multiple hypofluorescence spots, which are more discrete than fundus findings and correspond to hyporeflectivity seen in en face optical coherence tomography image at the ellipsoid zone level (b)
Angiography
Fluorescein angiography (FA) demonstrates early and late hyperfluorescence of the white dots. Early diffuse leakage of patchy appearance leaves late staining at the level of the deep retina (Fig. 5.4). Other less frequent findings include papillary leakage and focal retinal vascular stain. After resolution of fundus appearance, FA findings become normal soon, although subtle increased transmission may remain in the macula corresponding to the white dots or foveal granularity.
Fig. 5.4
Fluorescein angiography of Fig. 5.1 case. Leakage in the early phase (a) and staining in the late phase (b) are observed as patchy hyperfluorescence
ICGA shows normal large choroidal vessels in the early phase, and patchy hypofluorescent spots are numerous and distinct than the white dots seen clinically in the late phase (Fig. 5.5) (Ie et al. 1994). These spots represent effects of the RPE and photoreceptors on the choriocapillaris, rather than primary disturbance of the choroidal circulation. The abnormal findings of ICGA persist much longer than the clinical symptoms or fundus abnormalities, but disappear gradually (Tsukamoto et al. 1999).
Fig. 5.5
Late phase indocyanine green angiography of Fig. 5.2 case revealed multiple hypofluorescence spots which were not observed in fundus examination
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