Multimodal imaging in a case of macular vortex vein varix

Variceal dilations of vortex vein are not uncommon in eyes with high myopia. However, its occurrence in emmetropic eyes and posterior location has rarely been reported. We report a case of 55-year-old man who presented with a reddish orange sub-retinal lesion at the macula with subtle pulsation and collapse on pressure indentation. The lesion appeared hyerfluorescent on early frames of FFA with persistent silhouette in the late frames. ICGA showed dilated and tortuous vascular complex with hyperfluorescence in the mid phase without any evidence of late leakage. On SD–OCT the lesion appeared as a hypo-reflective sinusoidal space extending from the Hallers layer to the choriocapillary bed with distortion of the overlying RPE. The En-face Angio-OCT imaging was suggestive of a flow void sinusoidal tract with internal septa. The clinical features and collaborative findings on multimodal imaging were suggestive of variceal dilatation of the vortex vein ampulla.