Multimodal and clinical findings of three cases with stellate multiform amelanotic choroidopathy.
Gamze Ucan Gunduz, Betul Onal Gunay, Selim Doganay et al.
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Case in brief
Three patients aged 5, 10, and 38 years presented with unilateral yellowish choroidal lesions extending from the fovea toward the temporal macula and were diagnosed with stellate multiform amelanotic choroidopathy (SMACH) using multimodal imaging. Imaging showed subfoveal choroidal disorganization and irregular, undulating hyperreflective changes with focal protrusions in the retinal pigment epithelium/Bruch’s membrane complex. Subretinal fluid was present initially in two patients and developed during follow-up in the third. Two received intravitreal bevacizumab, but fluid persisted or fluctuated. Visual acuity remained stable in all three without further treatment; none had systemic findings.
What made this case unusual
The youngest patient was 5 years old, which the authors identify as the youngest age reported for SMACH. Subretinal fluid fluctuated or emerged during follow-up, while visual acuity remained stable.
Diagnostic / clinical pearl
In young patients with choroidal structural disorganization, consider SMACH and use multimodal imaging to recognize its characteristic choroidal and retinal pigment epithelium/Bruch’s membrane changes.
Why it matters
Recognizing SMACH may help avoid unnecessary interventions, including intravitreal injections or photodynamic therapy.