Materials and Methods: -This retrospective case series included three patients with isolated AS presenting with vitelliform lesions and SRF. All patients underwent comprehensive ophthalmic examination and multimodal imaging, including fundus autofluorescence (FAF), spectral-domain optical coherence tomography (SD-OCT), fluorescein angiography (FA), and optical coherence tomography angiography (OCTA). Clinical course, imaging findings, treatment responses, and long-term outcomes were evaluated.

Results: Six eyes of three patients were followed for a median follow-up of 7 years. PD-like vitelliform changes and persistent SRF were observed in all eyes. In three eyes, SRF occurred in the absence of MNV and ended up with prominent atrophy during follow up. In the remaining three eyes, MNV developed during follow-up and required anti-VEGF therapy, resulting in anatomical improvement. Notably, progressive outer retinal and retinal pigment epithelium (RPE) atrophy developed over time, regardless of MNV status or treatment. OCTA played a key role in distinguishing non-neovascular SRF from MNV-related exudation.

Conclusion: SRF in isolated AS may occur independent of MNV and is frequently associated with PD-like vitelliform changes. The presence of SRF alone should not be considered as an indicator of MNV. Multimodal imaging, particularly OCTA, is critical for accurate diagnosis and appropriate management. Despite treatment, progressive macular atrophy appears to be the main determinant of long-term visual outcome in these patients. Keywords : Angioid streaks, pattern dystrophy, serous foveal detachment, macular neovascularization, macular atrophy