Serous Maculopathy Due to Aspecific Choroidopathy (SMACH): A Case Report with Differential Diagnosis Based on Multimodal Imaging Analysis

Serous Maculopathy Due to Aspecific Choroidopathy (SMACH): A Case Report with Differential Diagnosis Based on Multimodal Imaging Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Serous Maculopathy Due to Aspecific Choroidopathy (SMACH): A Case Report with Differential Diagnosis Based on Multimodal Imaging Analysis Shuai Huang, Xuan Ren, Xinxin Yu, Xiangkun Qi, Shiwu Wang, Yan Sun This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8454252/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background Serous Maculopathy Due to Aspecific Choroidopathy (SMACH) is a rare chorioretinal disease characterized by polymorphic, non-pigmented choroidal lesions, with or without subretinal fluid (SRF). Its clinical manifestations overlap with common conditions such as central serous chorioretinopathy (CSC) and age-related macular degeneration (AMD), leading to a high risk of misdiagnosis, particularly in elderly patients. Multimodal imaging, including optical coherence tomography (OCT), OCT angiography (OCTA), fluorescein fundus angiography (FFA), and indocyanine green angiography (ICGA), is critical for accurate diagnosis. Case Presentation A 76-year-old Asian female presented with a 6-month history of blurred vision in her left eye. Ophthalmic examination revealed multiple yellowish-white subretinal lesions with mild elevation in the posterior pole of the left eye. OCT and OCTA demonstrated hyperreflective fibrinous exudates between the retinal pigment epithelium (RPE) and Bruch's membrane, choroidal thickening, and outer retinal damage. Fluorescein fundus angiography (FFA) and indocyanine green angiography (ICGA) provided complementary findings consistent with choroidal dysfunction and blood-retinal barrier disruption. Systemic evaluations, including laboratory tests for rheumatological immune indicators, tuberculin test, syphilis serology, and imaging examinations, excluded other systemic diseases. Based on these multimodal imaging findings and exclusion of alternative diagnoses, the patient was diagnosed with SMACH. Conclusions This case report describes a typical presentation of SMACH in an elderly patient, emphasizing that multimodal imaging, as demonstrated in this case, can help identify characteristic features of SMACH (choroidal thickening, hyperreflective exudates), though its diagnostic reliability in larger populations requires further validation.The exclusion of systemic diseases and differentiation from similar chorioretinal disorders (e.g., CSC, AMD) are crucial for accurate diagnosis.This case adds to the existing limited data on SMACH in elderly populations and further supports the role of multimodal imaging in improving diagnostic accuracy to reduce misdiagnosis. This case report describes a 76-year-old Asian female who presented with blurred vision in her left eye for six months. Ophthalmic examinations revealed multiple yellowish-white subretinal lesions with mild elevation in the posterior pole of the left eye. Optical coherence tomography (OCT) and OCT angiography (OCTA) indicated hyperreflective fibrinous exudates between the retinal pigment epithelium (RPE) and Bruch's membrane, choroidal thickening, and outer retinal damage. Combined with findings from fluorescein fundus angiography (FFA), indocyanine green angiography (ICGA), and exclusion of systemic diseases, the patient was diagnosed with Serous Maculopathy Due to Aspecific Choroidopathy (SMACH). Serous Maculopathy Due to Aspecific Choroidopathy Aspecific Choroidopathy Serous Maculopathy Macula Chorioretinopathy Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 11 May, 2026 Reviewers agreed at journal 30 Apr, 2026 Reviewers invited by journal 12 Feb, 2026 Editor assigned by journal 27 Dec, 2025 Submission checks completed at journal 27 Dec, 2025 First submitted to journal 26 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8454252","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":591951087,"identity":"b1b1cead-8643-4757-8b54-70f7a54e1437","order_by":0,"name":"Shuai Huang","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Shuai","middleName":"","lastName":"Huang","suffix":""},{"id":591951088,"identity":"dd4ef716-4a21-435f-8157-4deba1df172a","order_by":1,"name":"Xuan Ren","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Xuan","middleName":"","lastName":"Ren","suffix":""},{"id":591951089,"identity":"5b96c205-7a66-48bf-996a-750be2414d4d","order_by":2,"name":"Xinxin Yu","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Xinxin","middleName":"","lastName":"Yu","suffix":""},{"id":591951090,"identity":"76b834f3-5767-4ab9-a8e5-824028e8eed1","order_by":3,"name":"Xiangkun Qi","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Xiangkun","middleName":"","lastName":"Qi","suffix":""},{"id":591951091,"identity":"699d3671-b7d7-4db0-a37b-b89a04787984","order_by":4,"name":"Shiwu Wang","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Shiwu","middleName":"","lastName":"Wang","suffix":""},{"id":591951092,"identity":"acae9581-0dd8-4301-bb5f-219a73ad69b0","order_by":5,"name":"Yan Sun","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxUlEQVRIiWNgGAWjYBACNvnzDx98MLDhsW9vIFILnwQPs+GMgjQ5A54DRGqRk+Bhk+b5cNjYQCKBWIdJ9x6Q4DE4nLhd8vHGGww1NtGEtcicSzCQMEhP3Dk7rdiC4VhabgNBLQwJBgkGBtaJDbdzzCQYGw4Tp+VAggFzYsPNM8RqkcgxbDhg4GxscIOHWC08x5IZGwzS5CR7gH5JIMYv8u3Nx3//+WPDw89+eOONDzU2hLUgA+KjBkkLqTpGwSgYBaNgZAAAZ6o+nSPw6EIAAAAASUVORK5CYII=","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Yan","middleName":"","lastName":"Sun","suffix":""}],"badges":[],"createdAt":"2025-12-26 09:53:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8454252/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8454252/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102845997,"identity":"0f358b16-c027-40ef-af0a-26730d02962d","added_by":"auto","created_at":"2026-02-17 13:12:01","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":361428,"visible":true,"origin":"","legend":"","description":"","filename":"SerousMaculopathyDuetoAspecificChoroidopathy.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8454252/v1_covered_a5a295e6-f7bb-4c55-af29-0ed7f8828b99.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Serous Maculopathy Due to Aspecific Choroidopathy (SMACH): A Case Report with Differential Diagnosis Based on Multimodal Imaging Analysis","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"documenta-ophthalmologica","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"doop","sideBox":"Learn more about [Documenta Ophthalmologica](http://link.springer.com/journal/10633)","snPcode":"10633","submissionUrl":"https://submission.nature.com/new-submission/10633/3","title":"Documenta Ophthalmologica","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Serous Maculopathy Due to Aspecific Choroidopathy, Aspecific Choroidopathy, Serous Maculopathy, Macula, Chorioretinopathy","lastPublishedDoi":"10.21203/rs.3.rs-8454252/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8454252/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground Serous Maculopathy Due to Aspecific Choroidopathy (SMACH) is a rare chorioretinal disease characterized by polymorphic, non-pigmented choroidal lesions, with or without subretinal fluid (SRF). Its clinical manifestations overlap with common conditions such as central serous chorioretinopathy (CSC) and age-related macular degeneration (AMD), leading to a high risk of misdiagnosis, particularly in elderly patients. Multimodal imaging, including optical coherence tomography (OCT), OCT angiography (OCTA), fluorescein fundus angiography (FFA), and indocyanine green angiography (ICGA), is critical for accurate diagnosis.\u003c/p\u003e \u003cp\u003eCase Presentation A 76-year-old Asian female presented with a 6-month history of blurred vision in her left eye. Ophthalmic examination revealed multiple yellowish-white subretinal lesions with mild elevation in the posterior pole of the left eye. OCT and OCTA demonstrated hyperreflective fibrinous exudates between the retinal pigment epithelium (RPE) and Bruch's membrane, choroidal thickening, and outer retinal damage. Fluorescein fundus angiography (FFA) and indocyanine green angiography (ICGA) provided complementary findings consistent with choroidal dysfunction and blood-retinal barrier disruption. Systemic evaluations, including laboratory tests for rheumatological immune indicators, tuberculin test, syphilis serology, and imaging examinations, excluded other systemic diseases. Based on these multimodal imaging findings and exclusion of alternative diagnoses, the patient was diagnosed with SMACH.\u003c/p\u003e \u003cp\u003eConclusions This case report describes a typical presentation of SMACH in an elderly patient, emphasizing that multimodal imaging, as demonstrated in this case, can help identify characteristic features of SMACH (choroidal thickening, hyperreflective exudates), though its diagnostic reliability in larger populations requires further validation.The exclusion of systemic diseases and differentiation from similar chorioretinal disorders (e.g., CSC, AMD) are crucial for accurate diagnosis.This case adds to the existing limited data on SMACH in elderly populations and further supports the role of multimodal imaging in improving diagnostic accuracy to reduce misdiagnosis.\u003c/p\u003e \u003cp\u003eThis case report describes a 76-year-old Asian female who presented with blurred vision in her left eye for six months. Ophthalmic examinations revealed multiple yellowish-white subretinal lesions with mild elevation in the posterior pole of the left eye. Optical coherence tomography (OCT) and OCT angiography (OCTA) indicated hyperreflective fibrinous exudates between the retinal pigment epithelium (RPE) and Bruch's membrane, choroidal thickening, and outer retinal damage. Combined with findings from fluorescein fundus angiography (FFA), indocyanine green angiography (ICGA), and exclusion of systemic diseases, the patient was diagnosed with Serous Maculopathy Due to Aspecific Choroidopathy (SMACH).\u003c/p\u003e","manuscriptTitle":"Serous Maculopathy Due to Aspecific Choroidopathy (SMACH): A Case Report with Differential Diagnosis Based on Multimodal Imaging Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-17 13:10:38","doi":"10.21203/rs.3.rs-8454252/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-11T21:39:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"71171890576199179728739989488138386462","date":"2026-04-30T17:05:00+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-12T10:27:41+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-27T09:00:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-27T09:00:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"Documenta Ophthalmologica","date":"2025-12-26T09:42:30+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"documenta-ophthalmologica","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"doop","sideBox":"Learn more about [Documenta Ophthalmologica](http://link.springer.com/journal/10633)","snPcode":"10633","submissionUrl":"https://submission.nature.com/new-submission/10633/3","title":"Documenta Ophthalmologica","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"a475a99c-3e46-4240-a8a7-f9c309a36f80","owner":[],"postedDate":"February 17th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-11T21:39:33+00:00","index":23,"fulltext":""},{"type":"reviewerAgreed","content":"71171890576199179728739989488138386462","date":"2026-04-30T17:05:00+00:00","index":22,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-17T13:10:38+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-17 13:10:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8454252","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8454252","identity":"rs-8454252","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}