To report the novel imaging findings in persistent placoid maculopathy (PPM) from the first case series of Asian subjects. Retrospective observational case series. Patients with PPM included from 2013-2023. Medical records and multimodal imagings at each visit were analyzed. Imaging and follow-up findings. Twenty-one eyes of 16 patients were included. Mean age was 61 (range, 48-84) years old. Five patients were involved bilaterally. PPM lesions were unremarkable on color fundus photography, autofluorescence and fluorescein angiography. Hypofluorescence with lichen-like appearance presented in all phases of indocyanine green angiography, which were most prominent in the late-phase and presented in fused (71%) or clustered (29%) pattern. The hypofluorescence correlated to the lesions between retinal pigment epithelium (RPE) and Bruch's membrane (BM) with moderate reflectivity on OCT, the thickness of which ranged from thickening of the RPE-BM complex, slit-like to mound-like. The intensity of hypofluorescence may vary in the same eye, and correlated to the thickness of sub-RPE lesions on OCT. No abnormal blood flow signals were detected on either sub-RPE space or choriocapillaris slab of OCT angiography across the PPM lesions. Peripapillary (5 eyes, 24%) and extra posterior-pole (2 eyes, 10%) involvements were seen, with the former of which sparing the β zones of optic discs. Ten eyes of 7 patients were followed up (median, 26 months; range, 2-121 months). During follow-up, the lichen-like lesions spread and migrated slowly without changing the plane patterns of the first visit, and were limited to sub-RPE growth. The fused lichen-like pattern sprawled around the enlarged base. The clustered lichen-like pattern gradually loosened. Ten eyes (48%, 9 eyes in fused pattern, 1 eye in clustered pattern) had secondary choroidal neovascularization (CNV) at the first visit, with type I (6 eyes, 5 of which were polypoidal choroidal vasculopathy) and type II (4 eyes). No new CNV developed during follow-up. PPM lesions locate in the sub-RPE space, determined by multimodal imaging. Spreading and migration between RPE and BM may account for their unique lichen-like appearance and progression pattern.
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