Choroidal Circulation in Indolent, Nonprogressive, Multifocal Choroidal Lesions Evaluated by Multimodal Imaging Including Laser Speckle Flowgraphy

Background: Indolent, nonprogressive, multifocal choroidal lesions (INMCLs) are low-grade B-cell lymphoid infiltration with a good visual prognosis, yet their impact on choroidal circulation remains poorly understood. Clinical Significance: We report two cases of INMCLs evaluated via multimodal imaging, focusing on circulatory dynamics using laser speckle flowgraphy (LSFG). Case Presentation: Two patients (a 71-year-old female and a 54-year-old male) with histories of glaucoma presented with multiple yellow-white choroidal lesions at the posterior pole. Optical coherence tomography revealed extensive hyporeflective choroidal spaces in the outer choroid, while indocyanine green angiography (ICGA) showed corresponding hypofluorescent spots. Significantly, LSFG demonstrated regional reduction in LSFG signal, visualized as a “cold colour” pattern extending from the optic disc to the macula. Although both patients exhibited glaucomatous visual field changes, the extent to which INMCL contributed to the paracentral defects remains uncertain and difficult to separate from advanced glaucomatous damage. The clinical findings remained stable over several years without treatment. Conclusions: Our multimodal analysis leads to the tentative hypothesis that INMCLs may be associated with choroidal circulation disturbances, which could putatively stem from mechanical vascular compression due to localized lymphocyte accumulation. These cases highlight the potential utility of longitudinal LSFG in monitoring regional choroidal hemodynamics in INMCL, although its capability to differentiate INMCLs from other choroidal infiltrative diseases warrants validation in future comparative cohorts.