title: Ghost maculopathy: an artifact on near-infrared reflectance and multicolor imaging masquerading as chorioretinal pathology.
abstract: OBJECTIVE
  To describe the features of an artifact on near-infrared reflectance and MultiColor imaging, termed "ghost maculopathy," and to illustrate how it may masquerade as true chorioretinal pathology.
  
  
  METHODS
  This was a retrospective, observational case series.
  
  
  METHODS
  The authors studied 144 eyes of 72 consecutive patients in a vitreoretinal clinical practice, reviewing multimodal imaging including color and red-free fundus photography, fundus autofluorescence (FAF), near-infrared reflectance, MultiColor imaging, and spectral-domain optical coherence tomography (SD OCT).
  
  
  RESULTS
  In 36 of 144 eyes (25%), there was an appearance of a hyper-reflective spot on near-infrared reflectance and MultiColor imaging, located at the macula, nasal or superonasal to the fovea, which did not correspond to any apparent lesion on color and red-free fundus photography, FAF, or SD OCT. This spot was termed the "ghost image" in this phenomenon of "ghost maculopathy." The ghost image was present consistently on near-infrared reflectance and MultiColor imaging in all 36 eyes at every imaging encounter, showing minimal and subtle variability in its shape and location within each eye; however, it showed large interindividual variability in size, shape, location, and reflectivity between different eyes. Nine eyes were found to have a similar hyper-reflective spot resembling that in ghost maculopathy, but corresponding SD OCT images were consistent with diagnoses of choroidal nevus, age-related macular degeneration, and multifocal choroiditis. All eyes with ghost maculopathy were found to be pseudophakic with a posterior chamber intraocular lens.
  
  
  CONCLUSIONS
  Ghost maculopathy is the phenomenon of an imaging artifact appearing at the macula on near-infrared reflectance and MultiColor imaging that occurs predominantly in pseudophakic patients and may be mistaken for true chorioretinal pathology. Awareness of this artifact is prudent to avoid misinterpretation of clinical findings and possible unnecessary over-investigation.
authors.affiliation: The Vitreous, Retina, Macula Consultants of New York, New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York.
authors.forename: Claudine E
authors.initials: CE
authors.lastname: Pang
authors.affiliation: The Vitreous, Retina, Macula Consultants of New York, New York, New York; LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York; Department of Ophthalmology, New York University School of Medicine, New York, New York. Electronic address: kbfnyf@aol.com.
authors.forename: K Bailey
authors.initials: KB
authors.lastname: Freund
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016477:Artifacts; D002830:Choroid Neoplasms / Q000175:diagnosis*; D002833:Choroiditis / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007259:Infrared Rays; D008268:Macular Degeneration / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009508:Nevus, Pigmented / Q000175:diagnosis*; D019591:Pseudophakia / Q000209:etiology; D012164:Retinal Diseases / Q000175:diagnosis*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence