SMACH: A Rare, Non-Progressive Retinal Disorder - Key Insights into Its Clinical and Imaging Characteristics. A Case Report.

OBJECTIVE: To report a case of a Stellate Multiform Amelanotic Choroidopathy (SMACH). A newly recognized, rare retinal disorder that remains largely underreported in the literature. METHODS: Case report and review of literature. RESULTS: We present the case of a 67-year-old asymptomatic woman with a nasal parafoveal hypopigmented lesion. Multimodal imaging, including Optical Coherence Tomography, Optical Coherence Tomography Angiography, and fluorescein angiography, revealed hyperreflective choroidal thickening, minimal subretinal fluid, and a digitiform pattern, with no signs of neovascularization. DISCUSSION: SMACH is a rare, benign choroidal disorder whose variable clinical presentation can complicate accurate diagnosis. Understanding its non-progressive natural history is critical for differentiating it from vision-threatening pathologies, such as choroidal tumors, macular neovascularization, or pachychoroid spectrum diseases, reducing the risk of misdiagnosis and unnecessary therapeutic intervention. CONCLUSIONS: This case enhances our understanding of SMACH and underscores the value of multimodal imaging in identifying this rare condition, providing key insights into its diagnostic approach and natural course.