Case Report: Multimodal imaging of a macular vortex vein in a highly myopic eye.

Introduction: Macular vortex veins are a rare anatomical variant that can occur in highly myopic eyes. Their pathogenesis remains controversial, with some studies suggesting a congenital origin and others proposing acquired changes secondary to myopic progression. The presence of posterior staphyloma has been closely associated with these venous anomalies. Here, we report a case of macular vortex vein in a highly myopic eye, evaluated using multimodal imaging. Case presentation: A 51-year-old myopic female presented with a 2-week history of floaters in the right eye. She denied any prior ocular history other than refractive error, as well as any systemic chronic diseases or ocular trauma. Best-corrected visual acuity was 20/20 in the right eye and 20/25 in the left eye. Myopia was -6.5 D in the right eye and -6.75 D in the left eye. Ultra-widefield color fundus photography revealed dilation of the large choroidal vessels in the macular region of the left eye, with a prominent vortex vein ampulla. Infrared reflectance imaging clearly demonstrated the vortex vein branches converging toward the macula. Indocyanine green angiography (ICGA) showed centripetal convergence, well-defined contours, and unobstructed drainage of the macular vortex veins. Swept-source optical coherence tomography angiography (SS-OCTA) further revealed the medium-to-large choroidal vessel architecture. En face OCTA of the large-vessel choroidal slab clearly delineated the luminal structure of the macular vortex veins. Cross-sectional B-scans with flow overlay demonstrated the morphology of the vortex vein lumen. Conclusion: Macular vortex veins can occur in highly myopic eyes. Multimodal imaging, especially SS-OCTA, helps visualize this vascular variant clearly. Recognizing this benign finding is important to avoid misdiagnosis and unnecessary treatment.