(1) Indocyanine green angiography (ICG-A) shows the presence of mid-phase hyperfluorescent area in central serous chorioretinopathy (CSCR). However, their exact meaning remains uncertain. (2) The clinical and multimodal imaging findings of 100 patients (133 eyes) with CSCR, including the enhanced-depth-imaging OCT (EDI-OCT), blue-light fundus autofluorescence (BAF), fluorescein and indocyanine green angiography (FA and ICG-A) findings were reviewed. Mid-phase hyperfluorescent plaques (MPHP) were defined as fairly well circumscribed hyperfluorescent regions during the midphase of the ICG-A. The association between MPHP and other clinical/imaging parameters was assessed using a multiple logistic regression analysis. (3) MPHP were detected in 59.4% of eyes with CSCR. The chronic form of the disease, the presence of irregular pigment epithelium detachments (PED) and the retinal pigment epithelium (RPE) changes seen on FA were associated with the presence of MPHP in the multivariate analysis (p = 0.015; p = 0.018 and p = 0.002; respectively). OCT showed RPE bulges or PED in 98.7% of areas with MPHP and BAF showed changes in 57.3% of areas with MPHP. (4) MPHP were associated with a chronic form of CSCR and colocated with PED or RPE bulges. MPHP should be recognized as a sign of early RPE dysfunction before it is detected with BAF.

Purpose: To report the case of a small pigmented tumor in the macular region investigated using optical coherence tomography angiography (OCT-A) in the context of a multimodal approach. Methods: Case report Results: A 24-year-old man was referred for evaluation of an asymptomatic unilateral round comma-shaped pigmented tumor located in the macular region of his right eye. Spectral-domain OCT revealed an irregular hyperreflective mass within the retina, with a thickened hyaloid membrane and abrupt margins, and a complete posterior shadowing effect. On fluorescein angiography, early hyperfluorescence without leakage in the middle and late phases and a subtle halo of hyperfluorescence in the late phase were observed. OCT-A revealed the presence of intrinsic vascularization at the level of the inner capillary plexus, with signal intensity present at the level of the outer capillary plexus. In the superficial scans, the retinal vessels were oriented radially to the lesion and were in continuity with the vascular network within the tumor mass. No choroidal vessels could be identified. Conclusion: We report the case of a congenital simple hamartoma of the retinal pigment epithelium investigated using OCT-A as part of multimodal imaging. OCT-A provided a new insight in the assessment of the lesion, differential diagnosis, and follow-up of the patient. This imaging modality could be an important non-invasive tool in the management of congenital hamartomas of the retinal pigment epithelium.

Purpose: To evaluate the laterality of Coats disease by analyzing optical coherence tomography angiography features in affected, fellow, and control eyes. Methods: Patients with Coats disease who underwent optical coherence tomography angiography were retrospectively reviewed. Healthy eyes of age-matched patients served as controls. Automated optical coherence tomography angiography determination of foveal avascular zone size and vascular density of superficial capillary plexus and deep capillary plexus was recorded. Results: Thirty-four patients with Coats disease (13 with bilateral optical coherence tomography angiography) and 24 controls were included. The foveal avascular zone was larger in affected eyes compared with fellow eyes (P = 0.004). Vascular density was decreased in affected eyes compared with fellow eyes in the superficial capillary plexus and deep capillary plexus whole images (P = 0.047 and P = 0.007) and in the deep capillary plexus at the fovea (P = 0.001). Vascular density was significantly reduced only in the deep capillary plexus in Stage 1 or 2A patients but in both plexuses in patients with Stage 2B1. No differences were shown on foveal avascular zone and vascular density values between fellow eyes of patients with Coats disease and controls. Conclusion: The foveal avascular zone is enlarged, and vascular density is decreased in affected eyes with Coats disease, but no differences are seen between fellow and control eyes, confirming the unilateral nature of the disease.

Age-related cataract is the leading cause of visual impairment worldwide [1], accounting for 50% of blindness globally [2]. With an estimated 19.5 million procedures carried out in 2011 [3], cataract surgery is the most common ophthalmic surgical procedure. The past half-century has seen dramatic changes in the surgical techniques, which have translated to improvements in outcomes and safety [4]. Phacoemulsification (ultrasound) lens extraction and intraocular lens implantation was introduced 40 years ago and is now the standard method of cataract surgery in higher-income countries [5]. Dysphotopsiae are visual disturbances reported in up to 1 in 10 patients with uncomplicated cataract surgery and monofocal intraocular pressure (IOL) implantation [6]. Patients complain of dark shadows (dark dysphotopsia) or scintillations, haloes, peripheral or central flaring, or flashes (positive dysphotopsia). The improvement and adaptation to these symptoms may require several months without complete resolution and have a negative impact in the quality of life of a patient with an otherwise uncomplicated surgical procedure. Here we report the case of a bilateral pseudodonesis causing visual impairment as a new non-refractive, subjective visual complaint in a post-cataract patient.