Angiographic dark choroid in systemic non-hereditary amyloidosis

PURPOSE: To describe a novel finding of angiographic dark choroid in a patient with systemic non-hereditary amyloidosis. OBSERVATION: A 43-year old female with systemic light-chain amyloidosis associated with advanced kidney disease presented with metamorphopsia and blurry vision in both eyes of 1 year duration. Examination revealed subretinal yellowish deposits in the central macula and mid-periphery with patchy RPE mottling bilaterally. OCT demonstrated thickened choroid with a widened hyporeflective sub-Bruch's choriocapillaris band. FAF showed hypoautofluorescence of the central maculae with hyperautofluorescence flecks perifoveally. Fluorescein angiography demonstrated normal vascular filling without leakage and peripheral microaneurysms. The FA also revealed a strikingly diminished diffuse lack of choroidal fluorescence throughout all angiographic phases in both eyes which has not been previously described in this condition. CONCLUSIONSAND IMPORTANCE: This case demonstrates that patients with systemic amyloidosis may exhibit attenuation of choroidal signal (“dark choroid”) on fluorescein angiography, possibly due to accumulation of amyloid material in the sub-RPE space.