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Salt-and-pepper retinopathy: multimodal imaging of rubella retinopathy

      A 54-year-old female presented with congenital hearing loss and pigmentary retinopathy. She was diagnosed with congenital rubella retinopathy. Visual acuity was 20/25 in both eyes. Fundus examination showed bilateral granular pigmentary mottling in all 4 retinal quadrants in both eyes (Fig. A) corresponding to hypoautofluorescent spots on wide-field imaging (Fig. B). Optical coherence tomography angiography showed increased choroidal vessel rarefaction at the level of the choriocapillaris (left, blue arrows) and nummular hyperreflective lesions on scanning laser ophthalmoscopy near-infrared imaging (right) (Fig. C, yellow arrows). Corresponding retinal pigment epithelium and ellipsoid corrugations were seen on optical coherence tomography (top, red arrows) with increased flow transmission on B scans (bottom, green arrows) (Fig. D).
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