Fig. 5

The upper panels (a, b, c) illustrate the right eye of a patient with small sarcoid choroidal granulomas that appear as punctate hypofluorescent lesions with indocyanine green angiography (a). These small granulomas are not detected with OCTA at the level of the choriocapillaris (b) or by enhanced depth OCT (c). This may be because smaller granulomas initially grow in the loose connective stroma of the choroid without alteration of the vascular structure. Their diameter is approximately the size of a choriocapillaris lobule and may not be resolvable with spectral domain OCT. With progressive granuloma growth deeper into the loose choroidal connective tissue, the surrounding vasculature may be shifted and compressed, as illustrated in the bottom panels of the second case. Larger choroidal granulomas tend to occupy the full-thickness of the choroid as noted by the central choroidal hyporeflectance with EDI-OCT (f). This lesion can be visualized with OCTA as a central area of choriocapillaris blockage or non-flow (e) that colocalizes with ICG hypofluorescence (d)