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Stoyukhina AS. [OCT classification of choroidal nevi]. Vestn Oftalmol 2023; 139:49-62. [PMID: 37379109 DOI: 10.17116/oftalma202313903149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Choroidal nevi (CN) are commonly divided into non-suspicious (stable) and suscpicious (progressive). However, there are still no clear data on OCT patterns of nevi progression, their transformation into initial melanomas. PURPOSE The study aims to determine the types of OCT patterns of CN and to evaluate their prognostic value. MATERIAL AND METHODS The study included 50 patients with CN (53 nevi). The height of 19 nevi evaluated with ultrasonography was 1.33±0.43 mm, diameter - 5.47±1.68 mm. RESULTS CN is an area of local increase in reflectivity of the choroid; its widening and elevation of the tomographic section were observed in 72% of nevi. In more than half of all cases a distinct hyperreflective border was revealed between the CN and adjacent choroid. In two thirds of all cases the choriocapillaris layer was preserved and visualized mainly along the edge of lesion. Analysis of OCT scans showed distinct differences, which allowed designation of four OCT types of CN: 1) nevi with typical OCT pattern; 2) nevi with changes in retinal pigment epithelium (RPE); 3) nevi with neuroepithelial detachment; 4) nevi with atypical OCT pattern. CONCLUSION Based on the analysis of OCT images of the determined types of nevi, it can be assumed that all of them initially had typical OCT pattern. With enlargement of the nevi and increase in the duration of its presence in the choroid, dystrophic processes in the adjacent retina and changes in RPE begin to occur. Disturbed pumping ability of the damaged RPE results in disruption of the trophism of adjacent retina, which leads to development of atrophic changes. Nevi with atypical OCT pattern should be considered as a sign of long-term benign process in the choroid that will cause atrophic changes in the choroid and adjacent retina, while nevi with changes in RPE and with neuroepithelial detachment - as a risk factor for transition to choroidal melanoma.
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Affiliation(s)
- A S Stoyukhina
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
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Pergaris A, Danas E, Gajdzis P, Levidou G, Gajdzis M, Cassoux N, Gardrat S, Donizy P, Korkolopoulou P, Kavantzas N, Klijanienko J, Theocharis S. EPHA2, EPHA4, and EPHA6 Expression in Uveal Melanomas: Searching for the Culprits of Neoplasia. Diagnostics (Basel) 2022; 12:diagnostics12051025. [PMID: 35626181 PMCID: PMC9139903 DOI: 10.3390/diagnostics12051025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/07/2022] [Accepted: 04/14/2022] [Indexed: 12/02/2022] Open
Abstract
Uveal melanomas (UMs) comprise the most common primary intraocular malignancies in adults, with the eye representing the second most common site for melanoma, following the skin. Prognosis remains poor, with approximately half of the cases presenting with metastatic disease at the time of diagnosis. Erythropoietin-producing human hepatocellular receptors (EPHs) comprise the largest known family of tyrosine receptors, in which, along with their ligands, ephrins, play an important role in a plethora of processes in human physiology, and are implicated in key steps of carcinogenesis. In the present study, EPHA2, EPHA4, and EPHA6 immunohistochemical expressions were investigated in UM tissues and further correlated to a multitude of clinicopathological parameters, including disease stage and patients’ overall survival (OS). High levels of EPHA2 expression were significantly associated with increased tumor vertical thickness (p = 0.03) and the presence of intrascleral involvement (p = 0.05), whereas high EPHA6 nuclear expression was associated with older age at diagnosis (p = 0.03) and absence of retinal detachment (p = 0.05). In a multivariate survival analysis, increased EPHA4 expression was associated with shortened OS along with the presence of metastasis (p < 0.001) and monosomy 3 (p = 0.02). In a separate model, the concurrent overexpression of at least two of the investigated EPHs (HR = 14.7, p = 0.03) also proved to be an independent poor prognostic factor. In conclusion, our results implicate these specific members of the EPHA group as potential biomarkers for disease prognosis as well as possible targets for the development of novel therapeutic interventions.
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Affiliation(s)
- Alexandros Pergaris
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Bld. 10, Goudi, 11527 Athens, Greece; (A.P.); (E.D.); (G.L.); (P.K.); (N.K.)
| | - Eugene Danas
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Bld. 10, Goudi, 11527 Athens, Greece; (A.P.); (E.D.); (G.L.); (P.K.); (N.K.)
| | - Pawel Gajdzis
- Department of Clinical and Experimental Pathology, Division of Clinical Pathology, Wroclaw Medical
University, 50-556 Wroclaw, Poland; (P.G.); (P.D.)
| | - Georgia Levidou
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Bld. 10, Goudi, 11527 Athens, Greece; (A.P.); (E.D.); (G.L.); (P.K.); (N.K.)
- Department of Pathology, Paracelsus Medical University, 90419 Nuremberg, Germany
| | - Malgorzata Gajdzis
- Department of Ophthalmology, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Nathalie Cassoux
- Department of Ophthalmology, Institut Curie, 75005 Paris, France;
| | - Sophie Gardrat
- Department of Biopathology, Institut Curie, PSL Research University, 75005 Paris, France;
| | - Piotr Donizy
- Department of Clinical and Experimental Pathology, Division of Clinical Pathology, Wroclaw Medical
University, 50-556 Wroclaw, Poland; (P.G.); (P.D.)
| | - Penelope Korkolopoulou
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Bld. 10, Goudi, 11527 Athens, Greece; (A.P.); (E.D.); (G.L.); (P.K.); (N.K.)
| | - Nikolaos Kavantzas
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Bld. 10, Goudi, 11527 Athens, Greece; (A.P.); (E.D.); (G.L.); (P.K.); (N.K.)
| | | | - Stamatios Theocharis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, Bld. 10, Goudi, 11527 Athens, Greece; (A.P.); (E.D.); (G.L.); (P.K.); (N.K.)
- Correspondence: ; Tel.: +30-210-746-2116; Fax: +30-210-746-2157
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Al Harby L, Sagoo MS, O'Day R, Hay G, Arora AK, Keane PA, Cohen VML, Damato B. Distinguishing Choroidal Nevi from Melanomas Using the MOLES Algorithm: Evaluation in an Ocular Nevus Clinic. Ocul Oncol Pathol 2021; 7:294-302. [PMID: 34604203 PMCID: PMC8443944 DOI: 10.1159/000511363] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/02/2020] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE The aim of this study was to determine the sensitivity and specificity of the MOLES scoring system in differentiating choroidal melanomas from nevi according to Mushroom shape, Orange pigment, Large tumor size, Enlarging tumor, and Subretinal fluid (SRF). METHODS Color photographs, fundus-autofluorescence images, and optical coherence tomography of 222 melanocytic choroidal tumors were reviewed. Each MOLES feature was retrospectively scored between 0 and 2 and tumors categorized as "common nevus," "low-risk nevus," "high-risk nevus," and "probable melanoma" according to the total score. MOLES scores were compared with the experts' diagnosis of melanoma. RESULTS The MOLES scoring system indicated melanoma in all 81 tumors diagnosed as such by ocular oncologists (100% sensitivity) and nevus in 135 of 141 tumors given this diagnosis by these experts (95.7% specificity). Of the 6 tumors with discordant diagnoses, 4 had basal diameters exceeding 6 mm, all with SRF and/or orange pigment, and 2 small tumors showed either significant SRF with traces of orange pigment, or vice versa. CONCLUSIONS The MOLES system for diagnosing melanocytic choroidal tumors compares well with expert diagnosis but needs to be evaluated when deployed by ophthalmologists and community optometrists in a wide variety of working environments.
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Affiliation(s)
- Lamis Al Harby
- Ocular Oncology Service, Moorfields Eye Hospital, London, United Kingdom
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
- University College London Institute of Ophthalmology, London, United Kingdom
| | - Mandeep S. Sagoo
- Ocular Oncology Service, Moorfields Eye Hospital, London, United Kingdom
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
- University College London Institute of Ophthalmology, London, United Kingdom
| | - Roderick O'Day
- Ocular Oncology Service, Moorfields Eye Hospital, London, United Kingdom
| | - Gordon Hay
- Ocular Oncology Service, Moorfields Eye Hospital, London, United Kingdom
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
- University College London Institute of Ophthalmology, London, United Kingdom
| | - Amit K. Arora
- Ocular Oncology Service, Moorfields Eye Hospital, London, United Kingdom
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - Pearse A. Keane
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
- University College London Institute of Ophthalmology, London, United Kingdom
| | - Victoria M.-L. Cohen
- Ocular Oncology Service, Moorfields Eye Hospital, London, United Kingdom
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - Bertil Damato
- Ocular Oncology Service, Moorfields Eye Hospital, London, United Kingdom
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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Paez-Escamilla M, Jhingan M, Gallagher DS, Singh SR, Fraser-Bell S, Chhablani J. Age-related macular degeneration masqueraders: From the obvious to the obscure. Surv Ophthalmol 2020; 66:153-182. [PMID: 32971140 DOI: 10.1016/j.survophthal.2020.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 01/05/2023]
Abstract
Age-related macular degeneration (AMD) is one of the leading causes of blindness worldwide with increasing prevalence owing to increased life expectancy. Intravitreal injections of antivascular endothelial growth factor agents are commonly used in exudative AMD and oral antioxidant medication for nonexudative AMD; however, many disorders mimic exudative and nonexudative AMD, and misdiagnosis can seriously affect the management of these patients. We summarize the demographics and clinical and imaging characteristics of each of the conditions that masquerade as AMD. As some of the conditions have features of AMD, a short update on the classical features of AMD is also included.
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Affiliation(s)
- Manuel Paez-Escamilla
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mahima Jhingan
- Jacobs Retina Center at Shiley Eye Center, University of California, San Diego, La Jolla, California, USA
| | - Denise S Gallagher
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sumit Randhir Singh
- Jacobs Retina Center at Shiley Eye Center, University of California, San Diego, La Jolla, California, USA
| | | | - Jay Chhablani
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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Isolated choroidal melanocytosis: clinical update on 37 cases. Graefes Arch Clin Exp Ophthalmol 2020; 258:2819-2829. [PMID: 32902757 PMCID: PMC7677270 DOI: 10.1007/s00417-020-04919-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/10/2020] [Accepted: 08/27/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Isolated choroidal melanocytosis is a congenital melanocytic hyperpigmentation involving the choroid that is not associated with iridic or scleral features of ocular melanocytosis. The purpose of this work was to describe the clinical features and course of a relatively large series of patients with this disorder. METHODS A retrospective clinical study of 37 patients with isolated choroidal melanocytosis encountered in a single practice 1986-2018 was done. All lesions were 5 mm or larger in the largest basal diameter, homogeneously melanotic, and completely flat by conventional ocular ultrasonography. RESULTS The 37 patients ranged in age from 2 weeks to 87 years (mean 31.5 years, median 18 years) at initial diagnosis of the melanotic choroidal lesion. Arc length largest basal diameter of the melanotic choroidal lesion ranged from 5.5 to 37 mm (mean 14.6 mm, median 13 mm). The lesion extended beneath the fovea in 18 eyes and to the optic disc margin in 6 eyes. Ten of the lesions straddled the ocular equator, but the center point of all of the lesions was posterior to the equator. The retina was fully attached and appeared normal over the melanotic choroidal lesion in each of these eyes. None of the melanotic choroidal lesions exhibited clumps of orange pigment or drusen on its surface. The lesion was unilateral and unifocal in 36 of the 37 patients. One patient had bilateral choroidal melanocytosis that was isolated in one eye but associated with partial iris melanocytosis in the fellow eye. Three adult patients had a choroidal melanoma localized to the patch of choroidal melanocytosis at baseline. One other adult patient had a choroidal melanoma in the fellow eye at baseline. One pediatric patient had viable unilateral non-familial retinoblastoma in the fellow eye and two adult patients had a classic choroidal nevus in the fellow eye. None of the flat patches of choroidal melanocytosis that were monitored periodically after initial diagnosis expanded appreciably during follow-up ranging from 4.9 months to 15.2 years (mean 5.0 years, median 2.3 years). CONCLUSIONS Isolated choroidal melanocytosis is a distinct clinical entity that must be distinguished from broad-based choroidal nevus, choroidal melanocytoma, small choroidal malignant melanoma, acquired bilateral patchy-streaky choroidal melanocytic fundopathy associated with disorders such as cutaneous vitiligo and Waardenburg syndrome, acquired bilateral zonal choroidal melanocytic fundopathy, and diffuse uveal melanocytic proliferation associated with systemic cancer. This disorder appears to predispose affected eyes to development of choroidal melanoma arising from the hypermelanotic patch.
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Augsburger JJ. Focal aggregates of normal or near normal uveal melanocytes (FANNUMs) in the choroid: a distinct clinical and histopathological entity? Graefes Arch Clin Exp Ophthalmol 2020; 259:191-196. [PMID: 32712709 PMCID: PMC7790771 DOI: 10.1007/s00417-020-04851-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/30/2020] [Accepted: 07/14/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose To define, describe, and illustrate a previously unreported category of discrete melanotic choroidal melanocytic lesion. Methods Prospective ophthalmoscopic study of the ocular fundi of 79 light-skinned persons 50 years of age or older not referred for any evident fundus lesion, with detection of all evident discrete melanotic choroidal lesions > 0.3 mm in largest basal diameter. Results One or more discrete dark-brown to gray choroidal lesions > 0.3 mm in largest basal diameter were detected in 27 of the 79 evaluated subjects (34.2%). All but four of the detected lesions were “flat” by both ophthalmoscopy and ultrasonography. A single flat lesion was present in one eye of 14 subjects whose fellow eye was normal, 2 or more flat lesions were evident in one eye of 5 subjects whose other eye was normal, and one or more lesions were evident in both eyes of 6 subjects. Conclusion While some of the discrete small, flat melanocytic choroidal lesions detected in this study might have been choroidal nevi, the author hypothesizes that an indeterminate proportion of them may have been focal aggregates of normal or near normal uveal melanocytes (FANNUMs).
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Affiliation(s)
- James J Augsburger
- Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Viana KÍS, Dalgalarrondo PF, Correa Z, Jorge R. Choroidal nevus and polypoidal vasculopathy: case series. Int J Retina Vitreous 2020; 6:19. [PMID: 32514376 PMCID: PMC7265239 DOI: 10.1186/s40942-020-00223-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/22/2020] [Indexed: 11/20/2022] Open
Abstract
Background To report an association between choroidal nevus and polypoidal choroidal vasculopathy (PCV) in three patients. Case presentation We have encountered 3 isolated patients in our center presenting with subretinal exudation and a choroidal nevus that were thoroughly evaluated by slit lamp biomicroscopy, fundus photos, Fluorescein angiography (FA), indocyanine green angiography (ICG), B-scan ultrasound, and optical coherence tomography (SD-OCT—Heidelberg). The classic features of choroidal neovascularization seen on PVC were present in all 3 patients, all of whom had a substantial response to intravitreous antiangiogenic agent. OCT, Fluorescein and ICG Angiography, and Fundus autofluorescence (FAF) revealed similar findings in all cases. Discussion and conclusions We have identified a clinical pattern of PCV and choroidal nevus that can be diagnosed early using fluorescein angiography, ICG and OCT.
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Affiliation(s)
- Karlos Ítalo S Viana
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, 14049-900 Brazil
| | - Pedro F Dalgalarrondo
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, 14049-900 Brazil
| | - Zelia Correa
- Departments of Ophthalmology and Oncology, Wilmer Eye Institute, John Hopkins Medicine, Baltimore, USA
| | - Rodrigo Jorge
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, School of Medicine of Ribeirão Preto, University of São Paulo, Av. Bandeirantes 3900, Ribeirão Preto, 14049-900 Brazil
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Anzidei R, De La Mata G, Deane J. Polypoidal lesions associated to choroidal naevus: spectrum of pachychoroid disease? BMJ Case Rep 2018; 2018:bcr-2018-225571. [PMID: 30021743 PMCID: PMC6058106 DOI: 10.1136/bcr-2018-225571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2018] [Indexed: 11/03/2022] Open
Abstract
A 78-year-old woman was referred by an optician for an incidental finding of peripapillary naevus in the absence of visual symptoms. On examination, the right eye showed a choroidal naevus of around 1.5 disc diameter, adjacent to the optic disc. Optical coherence tomography detected the presence of pigment epithelium detachment and subretinal fluid within the context of the naevus. Fundus fluorescein angiography and indocyanine green showed multiple polypoidal lesions (Polypoidal Choroidal Vasculopathy, PCV) in the choroid within the spectrum of a pachychoroid, without any sign of malignancy related to neovascularisation. The patient underwent a follow-up of 6 months, showing stability of the lesions over this timeframe. No treatment has been required since the polypoidal lesions were outside the fovea and visual acuity remained stable. The association between choroidal naevi and polypoidal lesions is rare1; however, this seems to confirm that these findings are part of the spectrum of pachychoroid disease.
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Affiliation(s)
- Rossella Anzidei
- Department of Ophthalmology, Leicester Royal Infirmary, Leicester, UK
| | | | - James Deane
- Department of Ophthalmology, Leicester Royal Infirmary, Leicester, UK
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Keel S, Xie J, Foreman J, Taylor HR, Dirani M. Prevalence and characteristics of choroidal nevi: the Australian National Eye Health Survey. Clin Exp Ophthalmol 2018; 46:777-782. [DOI: 10.1111/ceo.13188] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/18/2018] [Accepted: 02/25/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Stuart Keel
- Centre for Eye Research Australia; Royal Victorian Eye and Ear Hospital; Melbourne Victoria Australia
| | - Jing Xie
- Centre for Eye Research Australia; Royal Victorian Eye and Ear Hospital; Melbourne Victoria Australia
| | - Joshua Foreman
- Centre for Eye Research Australia; Royal Victorian Eye and Ear Hospital; Melbourne Victoria Australia
- Department of Surgery; Ophthalmology, University of Melbourne; Melbourne Victoria Australia
| | - Hugh R Taylor
- Indigenous Eye Health Unit, Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Victoria Australia
| | - Mohamed Dirani
- Centre for Eye Research Australia; Royal Victorian Eye and Ear Hospital; Melbourne Victoria Australia
- Singapore Eye Research Institute; Singapore National Eye Centre; Singapore Singapore
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Shields CL, Pefkianaki M, Mashayekhi A, Shields JA, Ganguly A. Cytogenetic results of choroidal nevus growth into melanoma in 55 consecutive cases. Saudi J Ophthalmol 2018; 32:28-32. [PMID: 29755268 PMCID: PMC5944020 DOI: 10.1016/j.sjopt.2018.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/01/2018] [Indexed: 12/18/2022] Open
Abstract
Purpose To investigate the cytogenetic results of choroidal nevus with photographically-documented transformation into choroidal melanoma. Methods Retrospective analysis of 55 consecutive patients who underwent fine needle aspiration biopsy (FNAB) for DNA isolation and whole genome array based assay for chromosomes 3, 6, and 8 analysis prior to plaque radiotherapy. Tumors with abnormalities in chromosomes 3 and 8 were considered high-risk for metastasis. Results At diagnosis of choroidal nevus the mean patient age was 57 years (median 57, range 10–83 years). All patients were Caucasian and 36 (65%) were female. At the time of nevus diagnosis, the mean tumor basal diameter was 7.4 mm (median 6.5, range 1.5–18.0 mm) and tumor thickness was 2.2 mm (median 2.2, range 0.5–3.9 mm). The mean interval between diagnosis of choroidal nevus and transformation into choroidal melanoma was 58 months (median 42, range 3–238 months). At the time of melanoma diagnosis, the mean tumor basal diameter was 9.7 mm (median 9.0, range 5.0–19.0) and tumor thickness was 3.5 mm (median 3.4, range 1.3–8.1). Cytogenetic analysis of FNAB-isolated melanoma revealed 25 patients (45%) with high-risk and 30 (55%) with low-risk cytogenetic findings. The rate of tumor growth into melanoma was inversely related to high-risk cytogenetic profile (p = 0.03) as those with fast transformation ≤ 1 year showed high-risk in 80% compared to those with slow transformation > 1 year whoshowed high-risk profile in only 38%. Fast transformation into melanoma conferred a relative risk (RR) of 2.116 for high-risk cytogenetic profile, compared to slow transformation. Conclusions Choroidal nevus with rapid transformation into melanoma within 1 year is significantly more likely to demonstrate high-risk cytogenetic profile, at risk for metastatic disease, compared to those with slow transformation.
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Affiliation(s)
- Carol L. Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
- Corresponding author at: Ocular Oncology Service, 840 Walnut Street, Suite 1440, Philadelphia, PA 19107, USA. Fax: +1 (215) 928 1140.
| | - Maria Pefkianaki
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Arman Mashayekhi
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jerry A. Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Arupa Ganguly
- Department of Genetics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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Lee MD, Kaidonis G, Kim AY, Shields RA, Leng T. En Face Optical Coherence Tomography Angiography Imaging Versus Fundus Photography in the Measurement of Choroidal Nevi. Ophthalmic Surg Lasers Imaging Retina 2017; 48:741-747. [PMID: 28902335 DOI: 10.3928/23258160-20170829-09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/02/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Choroidal nevi are common benign intraocular tumors with a small risk of malignant transformation. This retrospective study investigates the use of en face spectral-domain optical coherence tomography angiography (SD-OCTA) in determining the clinical features and measurement of choroidal nevi. PATIENTS AND METHODS Patients with choroidal nevi were imaged with both OCTA and a fundus photography device. Greatest longitudinal dimension (GLD), perpendicular dimension (PD), and the GLD/PD ratio were assessed on each device. Inter-device variation and intra- and inter-rater reliability analyses were performed. RESULTS Fourteen patients with choroidal nevi were included. No significant difference between the GLD/PD ratio as measured by all three devices was found (Chi-square = 2.8, 2 df, P = .247). Intraclass correlation coefficients were greater than 0.7 for repeated measures on all devices, suggesting good repeatability and reproducibility. CONCLUSION This study demonstrated inter-device consistency and high intra- and inter-rater reliability when measuring choroidal nevi. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:741-747.].
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Abstract
PURPOSE OF REVIEW To review the prevalence, clinical features, imaging findings, cytogenetics, and risks and outcomes of choroidal nevus. RECENT FINDINGS Choroidal nevus is a benign melanocytic tumor, often discovered incidentally on ophthalmic examination. This lesion is generally well circumscribed and pigmented. The prevalence of choroidal nevus in postequatorial region in United States adults (≥40 years old) is approximately 5%. Choroidal nevus is associated with higher lifetime unopposed estrogen and greater BMI. In population-based evaluation, the mean nevus basal dimension is approximately 1.25 mm. Giant nevus (basal dimension ≥10 mm) carries greater risk for malignant transformation. Imaging modalities for evaluation of choroidal nevus include ultrasonography, fundus autofluorescence, and optical coherence tomography (OCT). Fluorescein angiography is occasionally employed to detect multifocal pinpoint leaks or choroidal neovascular membrane. Recently, OCT angiography demonstrated nevus with minimal overlying macular microvascular changes compared with melanoma. Cytogenetically, GNA11 or GNAQ mutations have been documented in uveal melanoma in 83% and in some cutaneous nevus subtypes. Further mutations lead to the development of melanoma at a rate of one of 8845 cases. Risk factors for transformation of nevus into melanoma are recalled by the mnemonic 'To find small ocular melanoma using helpful hints daily' representing thickness (T) more than 2 mm, subretinal fluid (F), symptoms (S) of flashes/floaters/blurred vision, orange (O) lipofuscin pigment, margin (M) less than 3 mm from optic disk, ultrasonographic hollowness (UH), halo (H) absence, and drusen (D) absence. The presence of three or more risk factors implies more than 50% chance for transformation to melanoma within 5 years. A new, online ocular oncology reading center can help judge nevus risk. SUMMARY Choroidal nevus is a common intraocular lesion, found predominantly in Whites. This mass carries a small risk (<1%) for malignant transformation. Patients with at least three risk factors should be evaluated for possible melanoma at an experienced ocular oncology center.
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Williams DS. Choroidal Nevi. J Insur Med 2016; 46:34-7. [PMID: 27562111 DOI: 10.17849/0743-6661-46.1.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Choroidal nevi are common benign melanocytic lesions of the posterior uvea.
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COMPARATIVE STUDY BETWEEN FUNDUS AUTOFLUORESCENCE AND RED REFLECTANCE IMAGING OF CHOROIDAL NEVI USING ULTRA–WIDE-FIELD SCANNING LASER OPHTHALMOSCOPY. Retina 2015; 35:1202-10. [DOI: 10.1097/iae.0000000000000463] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Putnam CM, Permann A, Bassi CJ. Comparison of retinal image evaluation techniques in novice clinicians. J Med Imaging (Bellingham) 2015; 2:025502. [PMID: 26158113 PMCID: PMC4478767 DOI: 10.1117/1.jmi.2.2.025502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 04/22/2015] [Indexed: 11/14/2022] Open
Abstract
Retinal fundus evaluation is learned through experience and training. This study aimed to determine the image presentation characteristics and the accompanying evaluation techniques, which led to the most accurate and efficient retinal pathology detection method. Phase I included 25 novice clinicians asked to evaluate 14 different pathologies using spatial versus temporal image presentations. Phase II included 25 different novice clinicians asked to evaluate five different simulated pathologies at three different pixel sizes presented in both spatial and temporal image presentations. Accuracy and speed of recognition were evaluated between the spatial and temporal presentations of the same simulated pathology. In phase l, subjects were significantly faster at simulated pathology detection using a temporal presentation with a 95% accuracy rate versus a spatial presentation with a 79% accuracy rate. In phase II, subjects demonstrated significant differences in speed of detection using the temporal technique at all 3 pixel number sizes with the greatest difference in detection times shown at the smallest retinal defects. Accuracy and speed of recognition in simulated pathology assessment were improved in a temporal presentation and the greatest improvements were demonstrated at the smallest pixel numbers.
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Affiliation(s)
- Christopher M. Putnam
- University of Missouri—St. Louis, College of Optometry, One University Boulevard, St. Louis, Missouri 63121-4400, United States
| | - Alex Permann
- University of Missouri—St. Louis, College of Optometry, One University Boulevard, St. Louis, Missouri 63121-4400, United States
| | - Carl J. Bassi
- University of Missouri—St. Louis, College of Optometry, One University Boulevard, St. Louis, Missouri 63121-4400, United States
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Asao K, Hashida N, Nishida K. Choroidal nevus in an eye with polypoidal choroidal vasculopathy. Case Rep Ophthalmol 2014; 5:463-7. [PMID: 25606040 PMCID: PMC4296248 DOI: 10.1159/000370044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose To report an eye with polypoidal choroidal vasculopathy (PCV) and a choroidal nevus. Methods This is an observational case report. Results A healthy 69-year-old woman was referred to the Osaka University Hospital with a diagnosis of a macular tumor. She complained of having distorted vision in her left eye. The medical history of the patient was unremarkable. At the initial examination, her best-corrected visual acuity (BCVA) was 20/20 in both eyes, and the intraocular pressure was 18 mm Hg in both eyes. A slit-lamp examination showed no abnormalities in the anterior segment of both eyes and a fundus examination of the left eye showed a slightly elevated juxtafoveal chorioretinal lesion and polyp-like reddish-orange lesions. The juxtafoveal choroidal lesion was located beneath a choroidal neovascularization (CNV). An optical coherence tomography confirmed CNV with pigment epithelial detachment (PED). Fluorescein angiography showed juxtafoveal hyperfluorescence due to CNV. Indocyanine green angiography demonstrated a branching choroidal vascular network that resembled polypoidal lesions. A fundus autofluorescence showed a mosaic pattern and a slight hyperautofluorescence at the CNV. We diagnosed the patient as having PCV. Aflibercept was injected intravitreally because of her PED. After the injection, PED improved and her visual acuity remained stable during the 12-month follow-up period. Conclusions In cases of PCV, FAF images are helpful in determining the status of the posterior pole. Intravitreal injections of aflibercept can improve PED associated with CNV, and the BCVA will remain stable for at least 12 months.
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Affiliation(s)
- Kazunobu Asao
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Noriyasu Hashida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
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Varner P. How frequently should asymptomatic patients be dilated? JOURNAL OF OPTOMETRY 2014; 7:57-61. [PMID: 24646902 PMCID: PMC3938739 DOI: 10.1016/j.optom.2013.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 02/08/2013] [Accepted: 02/08/2013] [Indexed: 06/03/2023]
Abstract
PURPOSE To determine if routine dilated fundus examination (DFE) should be performed sooner than at 10-year intervals in asymptomatic patients. METHODS Records for all patients consecutively evaluated in a one-year time frame were systematically reviewed. Of those patients who received initial DFE and were living 10 years later, records for sequential DFE were again evaluated to determine presence of clinically-significant, peripheral retinal findings. Databases were also searched in order to determine the number of patients during the same 10-year time period who developed vision or life-threatening peripheral retinal findings. The two groups were cross-matched to determine effectiveness of routine DFE. RESULTS Only 10 of 592 patients were deemed to have "clinically-significant" peripheral retinal findings--none of whom developed untoward outcomes. Of the 29 new retinal detachments and four intraocular tumors discovered during ten years of clinical follow-up, nearly 90% were symptomatic at the time of discovery. Three detachments and one tumor were detected as incidental findings in asymptomatic patients. No further treatment was recommended for the three detachments and the patient with the tumor survives, although with profound loss of vision in the involved eye. CONCLUSIONS In the absence of symptoms, routine DFE seems to have a very low yield for discovery of serious ocular events and appears to be ineffective in altering the course of incidental findings. Routine DFE is not indicated for older, asymptomatic patients--even at decade intervals. The findings of this study should be prospectively confirmed in population-based studies.
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Affiliation(s)
- Paul Varner
- John J Pershing Veterans Affairs Medical Center, Poplar Bluff, Missouri, USA.
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Tuncer S, Tugal-Tutkun I. Choroidal neovascularization secondary to choroidal nevus simulating an inflammatory lesion. Indian J Ophthalmol 2013; 61:305-6. [PMID: 23571241 PMCID: PMC3744788 DOI: 10.4103/0301-4738.99860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Choroidal nevi are the most common benign pigmented lesions of the fundus. Choroidal neovascularization is a rare complication of choroidal nevi. We report herein a young patient managed successfully with intravitreal bevacizumab injections for juxtapapillary choroidal neovascularization secondary to choroidal nevus simulating an inflammatory lesion.
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Affiliation(s)
- Samuray Tuncer
- Department of Ophthalmology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Russell-Hermanns D, Fernandes B, PV S, Burnier Jr M. Eye growth transformation: uveal melanoma. EXPERT REVIEW OF OPHTHALMOLOGY 2010. [DOI: 10.1586/eop.10.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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