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Cohen SY, Chowers I, Nghiem-Buffet S, Mrejen S, Souied E, Gaudric A. Subretinal autofluorescent deposits: A review and proposal for clinical classification. Surv Ophthalmol 2023; 68:1050-1070. [PMID: 37392968 DOI: 10.1016/j.survophthal.2023.06.009] [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] [Received: 03/09/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/03/2023]
Abstract
Subretinal autofluorescent deposits (SADs) may be found in the posterior pole, associated with very various conditions. These disorders usually present a typical pattern of autofluorescent lesions seen on short-wavelength fundus autofluorescence. We describe SADs according to their putative pathophysiological origin and also according to their clinical pattern, i.e., number, shape, and usual location. Five main putative pathophysiological origins of SADs were identified in disorders associated with an intrinsic impairment of phagocytosis and protein transportation, with excess of retinal pigment epithelium phagocytic capacity, with direct or indirect retinal pigment epithelium injury, and/or disorders associated with long-standing serous retinal detachment with mechanical separation between the retinal pigment epithelium and the photoreceptor outer segments. Clinically, however, they could be classified into eight subclasses of SADs, as observed on fundus autofluorescence as follows: single vitelliform macular lesion, multiple roundish or vitelliform lesions, multiple peripapillary lesions, flecked lesions, leopard-spot lesions, macular patterned lesions, patterned lesions located in the same area as the causal disorder, or nonpatterned lesions. Thus, if multimodal imaging may be required to diagnose the cause of SADs, the proposed classification based on noninvasive, widely available short-wavelength fundus autofluorescence could guide clinicians in making their diagnosis decision tree before considering the use of more invasive tools.
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Affiliation(s)
- Salomon Yves Cohen
- Ophthalmology Center for Imaging and Laser, Paris, France; Department of Ophthalmology, University of Paris-Est Créteil, Créteil, France.
| | - Itay Chowers
- Department of Ophthalmology, Hadassah Hospital, The Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Sarah Mrejen
- Ophthalmology Center for Imaging and Laser, Paris, France
| | - Eric Souied
- Department of Ophthalmology, University of Paris-Est Créteil, Créteil, France
| | - Alain Gaudric
- Ophthalmology Center for Imaging and Laser, Paris, France; Department of Ophthalmology, AP-HP, Hôpital Lariboisière, Université Paris Cité, Paris, France
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2
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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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3
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Bindewald-Wittich A, Holz FG, Ach T, Fiorentzis M, Bechrakis NE, Willerding GD. Fundus Autofluorescence Imaging in Patients with Choroidal Melanoma. Cancers (Basel) 2022; 14:cancers14071809. [PMID: 35406581 PMCID: PMC8997882 DOI: 10.3390/cancers14071809] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 12/15/2022] Open
Abstract
Simple Summary The ocular fundus contains molecules that emit fluorescence when excited with light of an appropriate wavelength. Fundus autofluorescence imaging is based on the in vivo detection of intrinsic fluorescence and results in topographic autofluorescence mapping of the ocular fundus. In contrast to fluorescence angiography, where the fluorescing agents need to be administered intravenously, autofluorescence imaging is a non-invasive technique. Even though choroidal melanomas do not contain significant autofluorescent molecules themselves, they may lead to secondary alterations in neighbouring tissues with an impact on the autofluorescence signal recording. Fundus autofluorescence imaging in the context of choroidal melanoma is helpful for differential diagnosis and for monitoring variations over time in affected patients before and after treatment. Abstract Choroidal melanocytic lesions require reliable and precise clinical examination and diagnosis to differentiate benign choroidal nevi from choroidal melanoma, as the latter may become life-threatening through metastatic disease. To come to an accurate diagnosis, as well as for monitoring, and to assess the efficacy of therapy, various imaging modalities may be used, one of which is non-invasive fundus autofluorescence (FAF) imaging using novel high-resolution digital imaging technology. FAF imaging is based on the visualization of intrinsic fluorophores in the ocular fundus. Lipofuscin and melanolipofuscin within the postmitotic retinal pigment epithelium (RPE) cells represent the major fluorophores that contribute to the FAF signal. In addition, the presence or loss of absorbing molecular constituents may have an impact on the FAF signal. A choroidal melanoma can cause secondary retinal and RPE alterations that affect the FAF signal (e.g., occurrence of orange pigment). Therefore, FAF imaging supports multimodal imaging and gives additional information over and above conventional imaging modalities regarding retinal metabolism and RPE health status. This article summarises the features of FAF imaging and the role of FAF imaging in the context of choroidal melanoma, both before and following therapeutic intervention.
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Affiliation(s)
- Almut Bindewald-Wittich
- Augenkompetenz Zentren Heidenheim, 89518 Heidenheim, Germany
- Augenkompetenz Zentren Bopfingen, 73441 Bopfingen, Germany
- Department of Ophthalmology, University of Bonn, 53127 Bonn, Germany; (F.G.H.); (T.A.)
- Correspondence:
| | - Frank G. Holz
- Department of Ophthalmology, University of Bonn, 53127 Bonn, Germany; (F.G.H.); (T.A.)
| | - Thomas Ach
- Department of Ophthalmology, University of Bonn, 53127 Bonn, Germany; (F.G.H.); (T.A.)
| | - Miltiadis Fiorentzis
- Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (M.F.); (N.E.B.)
| | - Nikolaos E. Bechrakis
- Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (M.F.); (N.E.B.)
| | - Gregor D. Willerding
- Department of Ophthalmology, DRK Kliniken Berlin Westend, 14050 Berlin, Germany;
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CHOROIDAL NEVUS IMAGING FEATURES IN 3,806 CASES AND RISK FACTORS FOR TRANSFORMATION INTO MELANOMA IN 2,355 CASES: The 2020 Taylor R. Smith and Victor T. Curtin Lecture. Retina 2020; 39:1840-1851. [PMID: 30608349 DOI: 10.1097/iae.0000000000002440] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To use multimodal imaging for identification of risk factors for choroidal nevus transformation into melanoma. METHODS Retrospective chart review of 3806 consecutive choroidal nevi with imaging and 2355 choroidal nevi with additional follow up to identify factors predictive of transformation of choroidal nevus into melanoma. RESULTS The median patient age was 62.5 years and Caucasian race in 3167 (95%). The choroidal nevus demonstrated median basal diameter of 4.0 mm and thickness of 1.4 mm. Imaging included optical coherence tomography (OCT) showing subretinal fluid (SRF) in 312 (9%), ultrasonography (US) with acoustic hollowness in 309 (9%), and hyper-autofluorescence (AF) in 100 (3%). Of those 2355 choroidal nevi with follow up, Kaplan-Meier estimates of nevus transformation into melanoma at 1, 5, and 10 years were 1.2%, 5.8%, and 13.9%, respectively. Multivariate analysis, using multimodal imaging for detection of factors predictive of nevus transformation into melanoma, included thickness >2 mm on US (hazard ratio (HR) 3.80, p < 0.0001), SRF on OCT as cap over nevus (HR 3.00, p < 0.0001) or SRF ≤3 mm from nevus margin (HR 3.56, p = 0.0003), symptomatic vision loss ≤20/50 on Snellen visual acuity (VA) (HR 2.28, p = 0.005), orange pigment (lipofuscin) hyperautofluorescence on AF (HR 3.07, p = 0.0004), acoustic hollowness on US (HR 2.10, p = 0.0020), and tumor diameter >5 mm on photography (HR 1.84, p = 0.0275). These factors can be recalled by the mnemonic "To Find Small Ocular Melanoma Doing IMaging" (TFSOM-DIM) representing Thickness >2 mm (US), Fluid subretinal (OCT), Symptoms vision loss (VA), Orange pigment (AF), Melanoma hollow (US), and DIaMeter >5mm (photography). The mean 5-year estimates of nevus growth into melanoma were 1% (HR 0.8) for those with 0 risk factor, 11% (HR 3.09) with 1 factor, 22% (HR 10.6) with 2 factors, 34% (HR 15.1) with 3 factors, 51% (HR 15.2) with 4 factors, 55% (HR 26.4) with 5 risk factors, and not-estimable with all 6 risk factors. CONCLUSION In this analysis, multimodal imaging was capable of detecting risk factors for nevus transformation into melanoma, including thickness >2 mm (US), fluid subretinal (OCT), symptoms vision loss (Snellen acuity), orange pigment (AF), melanoma hollowness (US), and diameter >5 mm (photography). Increasing number of risk factors imparts greater risk for nevus transformation into melanoma, including thickness >2 mm (US), fluid subretinal (OCT), symptoms vision loss (Snellen acuity), orange pigment (AF), melanoma hollowness (US), and diameter >5 mm (photography). Increasing number of risk factors imparts greater risk for transformation.
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5
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Fung AT, Guan R, Forlani V, Li YC, Chhablani J, Maltsev DS, Zur D, Iglicki M, Couturier A, Shinojima A, Almeida AC, Busch C, Lupidi M, Cagini C, Rishi P, Gabrielle PH, Fraser-Bell S, Amphornphruet A, Chotcomwongse P, Chen YH, Pellegrini M. Subclinical subretinal fluid detectable only by optical coherence tomography in choroidal naevi-the SON study. Eye (Lond) 2020; 35:2038-2044. [PMID: 33057241 DOI: 10.1038/s41433-020-01206-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Subretinal fluid is a risk factor for growth and malignant transformation of choroidal naevi, however it is unclear if this applies to subclinical fluid that is only detectable by optical coherence tomography (OCT). The objective of this study was to determine the prevalence and associations of subclinical but OCT-detectable subretinal fluid over choroidal naevi. METHODS Cross-sectional study of 309 consecutive cases of choroidal naevi imaged by OCT between July 2017 to January 2019. Multicentre international study involving ten retinal specialist centres. All patients presenting to retinal specialists had routine clinical examination and OCT imaging. The prevalence of subclinical OCT-detectable subretinal fluid over choroidal naevi and its associations with other features known to predict growth and malignant transformation were noted and analysed. RESULTS Of 309 identified consecutive cases, the mean patient age was 65 years, 89.3% of patients were Caucasian and 3.9% were Asian. The prevalence of subclinical but OCT-detectable subretinal fluid associated with choroidal naevi was 11.7% (36/309). Naevi with fluid were associated with larger basal diameters, greater thickness, presence of a halo, orange pigmentation, hyperautofluorescence, and hypodensity on B-scan ultrasonography. CONCLUSION AND RELEVANCE Of choroidal naevi where subretinal fluid is not visible on clinical examination, 11.7% demonstrate subretinal fluid on OCT scans. These naevi more commonly exhibit features known to be associated with growth and transformation to melanoma. The presence of subclinical OCT-detectable fluid over choroidal naevi may assist in their risk stratification.
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Affiliation(s)
- Adrian T Fung
- Westmead Clinical School, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, NSW, Australia. .,Central Clinical School, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, NSW, Australia. .,Department of Clinical Ophthalmology, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia.
| | - Raymond Guan
- Westmead Clinical School, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, NSW, Australia
| | - Veronica Forlani
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Yi-Chiao Li
- Central Clinical School, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, NSW, Australia.,Whitsunday Eye Surgery, Mackay, QLD, Australia
| | - Jay Chhablani
- University of Pittsburgh, UPMC Eye Center, Pittsburgh, PA, USA.,L.V. Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Dmitrii S Maltsev
- Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russia
| | - Dinah Zur
- Ophthalmology Division, Tel Aviv Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Matias Iglicki
- Private Retina Service, University of Buenos Aires, Buenos Aires, Argentina
| | - Aude Couturier
- Department of Ophthalmology, Lariboisière Hospital, AP-HP, Universitè Paris 7- Sorbonne Paris Citè, Paris, France
| | - Ari Shinojima
- Department of Ophthalmology, Lariboisière Hospital, AP-HP, Universitè Paris 7- Sorbonne Paris Citè, Paris, France.,Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Ana C Almeida
- Hospital Beatriz Ângelo, Lisbon, Portugal.,Nova Medical School-Universidade Nova de Lisboa, Lisbon, Portugal
| | - Catharina Busch
- Department of Ophthalmology, University Hospital Leipzig, Leipzig, Germany
| | - Marco Lupidi
- Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Carlo Cagini
- Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Pukhraj Rishi
- Ocular Oncology & Vitreoretina, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralya, Chennai, Tamilnadu, India
| | | | - Samantha Fraser-Bell
- Central Clinical School, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, NSW, Australia
| | - Atchara Amphornphruet
- Retina unit, Department of Ophthalmology, Rajavithi Hospital, Rangsit University, Bangkok, Thailand
| | - Peranut Chotcomwongse
- Retina unit, Department of Ophthalmology, Rajavithi Hospital, Rangsit University, Bangkok, Thailand
| | - Yan Hong Chen
- Westmead Clinical School, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, NSW, Australia
| | - Marco Pellegrini
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
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6
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Fung AT, Waldstein SM, Gal-Or O, Pellegrini M, Preziosa C, Shields JA, Welch RJ, Dolz-Marco R, Sarraf D, Nagiel A, Lalane R, Jung JJ, Ghazi NG, Ramtohul P, Arnold JJ, Sakurada Y, Choudhry N, Balaratnasingam C, Freund KB, Shields CL. Focal Scleral Nodule: A New Name for Solitary Idiopathic Choroiditis and Unifocal Helioid Choroiditis. Ophthalmology 2020; 127:1567-1577. [PMID: 32507351 DOI: 10.1016/j.ophtha.2020.04.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 04/09/2020] [Accepted: 04/15/2020] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To evaluate multimodal imaging findings of solitary idiopathic choroiditis (SIC; also known as unifocal helioid choroiditis) to clarify its origin, anatomic location, and natural course. DESIGN Multicenter retrospective observational case series. PARTICIPANTS Sixty-three patients with SIC in 1 eye. METHODS Demographic and clinical data were collected. Multimodal imaging included color fundus photography, OCT (including swept-source OCT), OCT angiography (OCTA), fundus autofluorescence, fluorescein and indocyanine green angiography, and B-scan ultrasonography. MAIN OUTCOME MEASURES Standardized grading of imaging features. RESULTS Mean age at presentation was 56 ± 15 years (range, 12-83 years). Mean follow-up duration in 39 patients was 39 ± 55 months (range, 1 month-25 years). The lesions measured a mean of 2.4 × 2.1 mm in basal diameter, were located inferior (64%) or nasal to the optic disc, and appeared yellow (53%). No systemic associations were found. The lesions all appeared as an elevated subretinal mass, with OCT demonstrating all lesions to be confined to the sclera, not the choroid. On OCT, the deep lesion margin was visible in 12 eyes with a mean lesion thickness of 0.6 mm. Overlying choroidal thinning or absence was seen in 95% (mean choroidal thickness, 28 ± 35 μm). Mild subretinal fluid was observed overlying the lesions in 9 patients (14%). Retinal pigment epithelial disruption and overlying retinal thinning was observed in 56% and 57%, respectively. OCT angiography was performed in 13 eyes and demonstrated associated choroidal and lesional flow voids. Four lesions (6%) were identified at the macula, leading to visual loss in 1 patient. One lesion demonstrated growth and another lesion showed spontaneous resolution. CONCLUSIONS In this largest series to date, multimodal imaging of SIC demonstrated a scleral location in all patients. The yellow and white clinical appearance may be related to scleral unmasking resulting from atrophy of overlying tissues. Additional associated features included documentation of deep margin on swept-source OCT, trace subretinal fluid in a few patients, and OCTA evidence of lesional flow voids. Because of the scleral location of this lesion in every patient, a new name, focal scleral nodule, is proposed.
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Affiliation(s)
- Adrian T Fung
- Westmead and Central (Save Sight Institute) Clinical Schools, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, Australia; Department of Ophthalmology, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Sebastian M Waldstein
- Westmead and Central (Save Sight Institute) Clinical Schools, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, Australia; Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
| | - Orly Gal-Or
- Vitreous Retina Macula Consultants of New York, New York, New York; Department of Ophthalmology, NYU School of Medicine, New York, New York; Rabin Medical Center, Petach Tikva, Israel
| | - Marco Pellegrini
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Chiara Preziosa
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Jerry A Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - R Joel Welch
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Rosa Dolz-Marco
- Vitreous Retina Macula Consultants of New York, New York, New York; Department of Ophthalmology, NYU School of Medicine, New York, New York; Unit of Macula, Oftalvist Clinic, Valencia, Spain
| | - David Sarraf
- Stein Eye Institute, University of California, Los Angeles, Los Angeles, California; Greater Los Angeles VA Healthcare Center, Los Angeles, California
| | - Aaron Nagiel
- Stein Eye Institute, University of California, Los Angeles, Los Angeles, California; Greater Los Angeles VA Healthcare Center, Los Angeles, California
| | - Robert Lalane
- Stein Eye Institute, University of California, Los Angeles, Los Angeles, California; Greater Los Angeles VA Healthcare Center, Los Angeles, California
| | - Jesse J Jung
- East Bay Retina Consultants, Inc., Oakland, California; Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Nicola G Ghazi
- Department of Ophthalmology, Gilbert and Rose-Marie Chagoury School of Medicine, The Lebanese American University and the Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
| | - Prithvi Ramtohul
- Centre Hospitalier Universitaire de l'Hôpital Nord, Marseille, France
| | | | - Yoichi Sakurada
- Vitreous Retina Macula Consultants of New York, New York, New York; Department of Ophthalmology, NYU School of Medicine, New York, New York; Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Netan Choudhry
- Vitreous Retina Macula Specialists of Toronto, Etobicoke, Canada
| | - Chandrakumar Balaratnasingam
- Lions Eye Institute, University of Western Australia, Perth, Australia; Department of Ophthalmology, Sir Charles Gairdner Hospital, Perth, Australia
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York; Department of Ophthalmology, NYU School of Medicine, New York, New York
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
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Abstract
Uveal melanoma (UM) is the most common primary intraocular malignancy in adults. UMs are usually initiated by a mutation in GNAQ or GNA11, unlike cutaneous melanomas, which usually harbour a BRAF or NRAS mutation. The annual incidence in Europe and the USA is ~6 per million population per year. Risk factors include fair skin, light-coloured eyes, congenital ocular melanocytosis, ocular melanocytoma and the BAP1-tumour predisposition syndrome. Ocular treatment aims at preserving the eye and useful vision and, if possible, preventing metastases. Enucleation has largely been superseded by various forms of radiotherapy, phototherapy and local tumour resection, often administered in combination. Ocular outcomes are best with small tumours not extending close to the optic disc and/or fovea. Almost 50% of patients develop metastatic disease, which usually involves the liver, and is usually fatal within 1 year. Although UM metastases are less responsive than cutaneous melanoma to chemotherapy or immune checkpoint inhibitors, encouraging results have been reported with partial hepatectomy for solitary metastases, with percutaneous hepatic perfusion with melphalan or with tebentafusp. Better insight into tumour immunology and metabolism may lead to new treatments.
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8
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Dalvin LA, Shields CL, Ancona-Lezama DA, Yu MD, Di Nicola M, Williams BK, Lucio-Alvarez JA, Ang SM, Maloney SM, Welch RJ, Shields JA. Combination of multimodal imaging features predictive of choroidal nevus transformation into melanoma. Br J Ophthalmol 2018; 103:1441-1447. [PMID: 30523045 DOI: 10.1136/bjophthalmol-2018-312967] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 11/13/2018] [Accepted: 11/16/2018] [Indexed: 12/16/2022]
Abstract
AIM To characterise combinations of multimodal imaging risk factors and predictive value for choroidal nevus transformation into melanoma. METHODS This is a retrospective review of multimodal imaging features for 3806 choroidal nevi from 1 January 2007 through 1 January 2017. Kaplan-Meier estimates and Cox regression analyses were used to calculate 5-year percentages of growth to melanoma and HR. RESULTS Using multimodal imaging, six risk factors predictive of choroidal nevus transformation into melanoma were identified, namely tumour thickness >2 mm, subretinal fluid, symptoms of visual acuity loss to 20/50 or worse, orange pigment, hollow acoustic density and tumour largest basal diameter >5 mm. Kaplan-Meier 5-year estimated tumour growth was found in 1% of nevi with no risk factors, 11% (range 9%-37%) with one factor, 22% (12%-68%) with two factors, 34% (21%-100%) with three factors, 51% (0%-100%) with four factors and 55% (0%-100%) with five factors. HR for growth was 0.1 with no factor, 2.1-7.8 with one factor, 1.8-12.1 with two factors, 4.0-24.4 with three factors, 4.6-170.0 with four factors and 12.0-595.0 with five factors. The highest HR with each combination of two, three, four or five risk factors always included symptoms of visual acuity loss and orange pigment. CONCLUSION Six risk factors for choroidal nevus transformation into melanoma by multimodal imaging have been identified. Risk for transformation into melanoma is 1% when no factors are present, and approaches 100% with specific combinations of three or more risk factors. Understanding how combinations of factors influence risk of transformation into melanoma can guide counselling and treatment decisions.
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Affiliation(s)
- Lauren A Dalvin
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - David Arturo Ancona-Lezama
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael D Yu
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Maura Di Nicola
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Basil K Williams
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - J Antonio Lucio-Alvarez
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Su Mae Ang
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sean M Maloney
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - R Joel Welch
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jerry A Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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9
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Hrynchak P, Hugh J, Labreche T. Bilateral isolated choroidal melanocytosis with isoautofluorescence. Can J Ophthalmol 2018; 53:e97-e99. [PMID: 29784187 DOI: 10.1016/j.jcjo.2017.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 08/31/2017] [Accepted: 09/06/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Patricia Hrynchak
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Ont.
| | - Jennifer Hugh
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Ont
| | - Tammy Labreche
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Ont
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10
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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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Kaur G, Anthony SA. Multimodal imaging of suspicious choroidal neoplasms in a primary eye-care clinic. Clin Exp Optom 2017; 100:549-562. [PMID: 28370509 DOI: 10.1111/cxo.12537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 01/05/2017] [Indexed: 11/28/2022] Open
Abstract
Small suspicious choroidal neoplasms commonly present a diagnostic challenge in primary eye-care clinics, where they are most likely to present. Differentiating benign from malignant choroidal neoplasms is essential for facilitating early diagnosis and treatment, potentially decreasing the risk of metastasis and vision loss in some cases. The purpose of this review is to describe the clinical, spectral-domain optical coherence tomography and fundus autofluorescence features of suspicious choroidal neoplasms in a case series of patients presenting to a primary eye-care clinic at the Veterans Health Administration, Cleveland, Ohio, USA.
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Affiliation(s)
- Gurpinderjeet Kaur
- Optometry Clinic, Louis Stokes Cleveland Veterans Affairs Medical Centre, Cleveland, Ohio, USA
| | - Scott A Anthony
- Optometry Clinic, Louis Stokes Cleveland Veterans Affairs Medical Centre, Cleveland, Ohio, USA
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Abstract
Fundus autofluorescence (FAF) is a relatively new imaging technique that can be used to study retinal diseases. It provides information on retinal metabolism and health. Several different pathologies can be detected. Peculiar AF alterations can help the clinician to monitor disease progression and to better understand its pathogenesis. In the present article, we review FAF principles and clinical applications.
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Affiliation(s)
| | | | - Paolo Lanzetta
- Department of Medical and Biological Sciences - Ophthalmology, University of Udine, Udine; Istituto Europeo di Microchirurgia Oculare, Udine, Italy
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Samuelsson D, Sznage M, Engelsberg K, Wittström E. Clinical, optical coherence tomography, and fundus autofluorescence findings in patients with intraocular tumors. Clin Ophthalmol 2016; 10:1953-1964. [PMID: 27784984 PMCID: PMC5063485 DOI: 10.2147/opth.s109222] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To describe clinical, optical coherence tomography (OCT) and fundus autofluorescence (FAF) findings in patients with intraocular tumors and determine if OCT and FAF could be helpful in the differential diagnosis and management of different choroidal tumors. METHODS Forty-nine patients with untreated, macular, midperipheral, and extrapapillary intraocular tumors were included. All patients underwent ophthalmic examination: best-corrected visual acuity, slit-lamp biomicroscopy, funduscopy, and standardized B mode, and if possible A mode, ultrasonography, and OCT and FAF imaging of the surface of the intraocular tumors. RESULTS Of the 49 patients studied, 19 had choroidal nevi, ten had indeterminate choroidal melanocytic lesions (IMLs), ten had malignant melanomas, and ten had other choroidal tumors. The choroidal nevi revealed subretinal fluid (SRF) on OCT in only 11%. FAF detected isoauto-fluorescence in 42%, hypoautofluorescence in 37%, patchy FAF pattern in 16%, and a diffuse FAF pattern in 5%. Seventy percent of patients with IML showed SRF on OCT and 20% showed tumor growth on follow-up, detected only by OCT and FAF imaging. FAF revealed a patchy pattern in 50% and a diffuse pattern in 40% of cases with IML. Ninety percent of the patients with choroidal melanoma had SRF on OCT and FAF revealed a patchy pattern in 60% and a diffuse pattern in 40%. Patients with other choroidal tumors had SRF on OCT in 30% of cases and no characteristic pattern on FAF. CONCLUSION Both OCT and FAF were helpful in the differential diagnosis of choroidal nevi versus IMLs, choroidal melanomas, and other choroidal tumors. Also, detailed and periodical clinical evaluation of patients with intraocular tumors using OCT and FAF imaging for the detection of both SRF and FAF patterns overlying the tumor can be useful for detection of tumor growth.
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Affiliation(s)
- Daniel Samuelsson
- Department of Ophthalmology, Lund University, Skane University Hospital, Lund, Sweden
| | - Monika Sznage
- Department of Ophthalmology, Lund University, Skane University Hospital, Lund, Sweden
| | - Karl Engelsberg
- Department of Ophthalmology, Lund University, Skane University Hospital, Lund, Sweden
| | - Elisabeth Wittström
- Department of Ophthalmology, Lund University, Skane University Hospital, Lund, Sweden
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Balaskas K, Gray J, Blows P, Rajai A, Flaye D, Peto T, Sagoo MS. Management of choroidal naevomelanocytic lesions: feasibility and safety of a virtual clinic model. Br J Ophthalmol 2015; 100:665-70. [PMID: 26347525 DOI: 10.1136/bjophthalmol-2015-307168] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 08/11/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Choroidal naevomelanocytic lesions are often identified as an incidental finding by community optometrists and referred for expert evaluation in hospital eye units or specialist ocular oncology centres. Optimal management strategy is undecided and most centres err on the side of caution. Our aim was to test a virtual model of service delivery relying on interpretation of imaging test results by non-medically trained graders. METHODS Patients with naevomelanocytic lesions referred to Manchester Royal Eye Hospital and Moorfields Eye Hospital were retrospectively included in this study. All patients underwent imaging tests including optical coherence tomography and ultrasound and management was subsequently decided clinically. Images were anonymised and transferred to the Moorfields Eye Hospital Reading Centre and were reviewed by a trained, masked grader who reached a management decision on the basis of a specific grading protocol. Agreement between decisions made on the basis of clinical examination and imaging ('gold standard') by an expert ophthalmologist in the clinic was compared with the decisions made by a masked ophthalmologist and a masked non-medical grader based on imaging tests alone. RESULTS There were 102 consecutive patients included in this study. Agreement between gold-standard clinical management and decisions made by masked, non-medical grader and masked ophthalmologist on the basis of imaging test results alone was 96.1% (κ=0.97) and 100%, respectively. CONCLUSIONS In this pilot study, a streamlined, dedicated, virtual service for rapid assessment (within 2 weeks of referral) of choroidal naevomelanocytic lesions was shown to be feasible and safe. Such a model of service delivery may prove cost-efficient while optimising patient experience. Further prospective studies are required for formal validation of the proposed service model.
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Affiliation(s)
- Konstantinos Balaskas
- The Royal Eye Hospital, Manchester, UK Centre for Hearing and Vision Research, University of Manchester, Manchester, UK NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and at UCL Institute of Ophthalmology, London, UK
| | - Jane Gray
- The Royal Eye Hospital, Manchester, UK
| | - Peter Blows
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and at UCL Institute of Ophthalmology, London, UK
| | - Azita Rajai
- Department of Research and Innovation, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Deidre Flaye
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and at UCL Institute of Ophthalmology, London, UK
| | - Tunde Peto
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and at UCL Institute of Ophthalmology, London, UK
| | - Mandeep S Sagoo
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and at UCL Institute of Ophthalmology, London, UK
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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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Abstract
UNLABELLED The prevalence of choroidal nevi (CN) ranges from 1% to 10%. It may be hard to differentiate a small melanoma from an atypical ("malignatized") CN, which occupies an intermediate position between typical nevi and actual melanomas and can be referred to as "progressive" or "suspicious". The risk of malignant transformation of a CN ranges from 0.78% to 7%, thus necessitating the need for a detailed description of its clinical features. OBJECTIVE To study clinical features of choroidal nevi in conjunction with their growth patterns. MATERIAL AND METHODS A total of 80 patients (84 eyes) with choroidal nevi were studied, including 23 men and 57 women aged 65.33±3.26 years on average. The follow-up period was 12-48 months. In 26 cases (30.95%) age-related macular degeneration (AMD) was also present. RESULTS Choroidal nevus is generally more common in women (71.25%). The right eye was involved in 36 cases, the left--in 48. Bilateral CN was diagnosed in 5% of cases. The follow-up period was 12-48 months. The nevi were mostly located in the juxtapapillary (11.9%) and macular (29.76%) regions. In 10 eyes they spread to the parafovea and foveola. The shape was typically round (73.8%), in the rest of cases--oval (26.2%). The size at presentation varied from 1 mm to 9 mm (2.93 mm on average). Diagnostic features of a stationary nevus (does not require a follow-up) have been identified. Nevus enlargement and changes in the overlying retina are indicative of progression. CONCLUSION On the basis of clinical presentation all choroidal nevi can be classified as either stationary or progressing. If progression is suspected, a close follow-up is required. Progressive destruction of the overlying retina and early signs of visual impairment are risk factors for melanoma development.
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Affiliation(s)
- A F Brovkina
- Russian Medical Academy of Postgraduate Education, Department of Ophthalmology, 2/1 Barrikadnaya St., Moscow, Russian Federation, 123995
| | - A S Stoyukhina
- Research Institute of Eye Diseases, 11 A,B, Rossolimo St., Moscow, Russian Federation, 119021
| | - Z S Popova
- Polyclinic No. 1 of the Administrative Department of the President of the Russian Federation, 26/28 Sivtsev Vrazhek pereulok, Moscow, Russian Federation, 119002
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Abstract
Melanoma of the eye can involve the uveal tract with iris, ciliary body, or choroid involvement or it can involve the conjunctiva, eyelid, or orbit. Uveal involvement with choroidal melanoma is the most common, found in light complexion Caucasians with an age-adjusted incidence of 4.3 per million persons. Early detection of uveal melanoma is critical. The ABCDEF guide helps to differentiate iris nevus from iris melanoma. The letters represent: A, age young (≤40 years); B, blood in anterior chamber; C, clock hour of mass inferiorly; D, diffuse configuration; E, ectropion; and F, feathery margins. The mnemonic of TFSOM-UHHD (To Find Small Ocular Melanoma-Using Helpful Hints Daily) helps to differentiate choroidal nevus from small melanoma and represents: T, thickness over 2 mm; F, fluid; S, symptoms; O, orange pigment; M, margin within 3 mm of the optic disc; UH, ultrasound hollow; H, halo absent; and D, drusen absent. Patients with 3 or more of these factors are likely to have melanoma. These key clinical features help to identify small melanoma at a time when therapy could be life-saving. Conjunctival melanoma usually arises from primary acquired melanosis, a flat pigmentation that can lead to melanoma. Wide excision using no touch strategy is important to tumor control. Ocular examination is advised annually for all persons for detection of refractive error, cataract, glaucoma, and other conditions, but also for the detection of asymptomatic malignancies like melanoma. One at a time, we have uncovered the secrets of ocular melanoma and we forge ahead with the goal to solve the riddle of this challenging disease.
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Affiliation(s)
- Carol L Shields
- The Ocular Oncology Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
| | - Jane Grant Kels
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT
| | - Jerry A Shields
- The Ocular Oncology Service, Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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Shields JA, Shields CL. Management of posterior uveal melanoma: past, present, and future: the 2014 Charles L. Schepens lecture. Ophthalmology 2014; 122:414-28. [PMID: 25439609 DOI: 10.1016/j.ophtha.2014.08.046] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 08/26/2014] [Accepted: 08/27/2014] [Indexed: 01/16/2023] Open
Abstract
PURPOSE To review the management of ciliary body and choroidal melanoma (posterior uveal melanoma [PUM]) over the last century with an emphasis on changing concepts. DESIGN Retrospective review. PARTICIPANTS Review of personal experience over 40 years and pertinent literature on management of PUM. METHODS Diagnosis and therapy for PUM. MAIN OUTCOME MEASURES Patient survival. RESULTS In the early 1900s, most patients presented with a large symptomatic melanoma that necessitated enucleation, and the systemic prognosis was poor. In the 1970s, controversy erupted regarding the role of enucleation for PUM. Some authorities advocated prompt enucleation, and others proposed that enucleation promoted metastasis, known as the "Zimmerman hypothesis." Others recommended observation, withholding treatment until tumor growth was documented. During the 1970s, there was a trend toward eye-saving procedures, including laser photocoagulation, surgical removal of tumor, and techniques of radiotherapy. Despite local treatment success, systemic prognosis remained guarded with approximately 40% mortality overall. However, there was convincing evidence that smaller tumors offered a significantly better prognosis. Currently, there is a movement toward earlier identification and treatment of small melanomas using clinical factors predictive of malignant potential, in keeping with similar philosophy regarding other cancers. Further understanding of melanoma cytogenetics and molecular pathways have helped to recognize patients at risk for metastasis. At-risk patients are offered systemic therapeutic trials to prevent metastasis. We anticipate that the future management of PUM will focus on detection of clinical and imaging clues for earliest diagnosis, prompt local tumor treatment, and systemic targeted therapies for microscopic metastasis or prevention of metastasis. Personalized evaluation of patient-specific melanoma molecular pathway signature could allow for therapeutic intervention at a site specific to the pathway abnormality that leads to the development of melanoma. CONCLUSIONS Management of PUM has made major strides over the past century from the days of enucleation for massive, fatal tumor to early detection of smallest tumors with a more favorable prognosis. Current and future targeted specific tumor pathway interruption using systemic agents could improve survival.
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Affiliation(s)
- Jerry A Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
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Gordon-Shaag A, Barnard S, Millodot M, Gantz L, Chiche G, Vanessa E, Ruth W, Pinchasov R, Gosman Z, Simchi M, Koslowe K, Shneor E. Prevalence of choroidal naevi using scanning laser ophthalmoscope. Ophthalmic Physiol Opt 2013; 34:94-101. [DOI: 10.1111/opo.12092] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 09/26/2013] [Indexed: 02/03/2023]
Affiliation(s)
| | - Simon Barnard
- Department of Optometry; Hadassah Academic College; Jerusalem Israel
| | - Michel Millodot
- School of Optometry; The Hong Kong Polytechnic University; Hong Kong PR China
| | - Liat Gantz
- Department of Optometry; Hadassah Academic College; Jerusalem Israel
| | - Gabrielle Chiche
- Department of Optometry; Hadassah Academic College; Jerusalem Israel
| | - Elbaz Vanessa
- Department of Optometry; Hadassah Academic College; Jerusalem Israel
| | - Wolff Ruth
- Department of Optometry; Hadassah Academic College; Jerusalem Israel
| | - Rima Pinchasov
- Department of Optometry; Hadassah Academic College; Jerusalem Israel
| | - Zoya Gosman
- Department of Optometry; Hadassah Academic College; Jerusalem Israel
| | - Merav Simchi
- Department of Optometry; Hadassah Academic College; Jerusalem Israel
| | - Kenneth Koslowe
- Department of Optometry; Hadassah Academic College; Jerusalem Israel
| | - Einat Shneor
- Department of Optometry; Hadassah Academic College; Jerusalem Israel
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Fung AT, Kaliki S, Shields CL, Mashayekhi A, Shields JA. Solitary idiopathic choroiditis: findings on enhanced depth imaging optical coherence tomography in 10 cases. Ophthalmology 2012; 120:852-8. [PMID: 23246121 DOI: 10.1016/j.ophtha.2012.09.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 08/18/2012] [Accepted: 09/11/2012] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To describe the imaging characteristics of solitary idiopathic choroiditis (SIC). DESIGN Retrospective, observational case series. PARTICIPANTS Ten eyes in 10 patients with SIC. METHODS Review of chart, fundus photography, ultrasonography, fundus autofluorescence (FAF), infrared reflectance (IR) imaging, and enhanced depth imaging optical coherence tomography (EDI OCT). MAIN OUTCOME MEASURES Scleral, choroidal, and retinal features of SIC as analyzed by EDI OCT. RESULTS The mean age at diagnosis was 47 years (range, 7-76 years). There were 4 male patients and 6 female patients. The mean best-corrected visual acuity was 20/25 (range, 20/20-20/150). The SIC lesions were postequatorial (n = 10), with a mean basal diameter of 2.6 mm (range, 1.0-4.0 mm), yellow hue (n = 10), and surrounding orange halo (n = 6). Ultrasonography revealed acoustic solidity (n = 10) with a mean thickness of 1.7 mm (range, 1.4-2.1 mm), FAF disclosed hyperautofluorescence (n = 9), and IR imaging displayed hyperreflectivity (n = 9). On EDI OCT, all 10 lesions were dome shaped with a smooth surface and arose with a gentle slope from the sclera. A more abruptly elevated volcanic configuration was seen in 2 lesions. The overlying choroid was thinned (mean thickness, 32 μm; range, 0-52 μm). The lesions were moderately reflective with an optically bright anterior band and deep shadowing (n = 8). The posterior margin of the lesion could be ascertained in only 1 case. By EDI OCT, the mean diameter was 2942 μm (range, 1887-3809 μm). In no case was there disturbance of the inner retina or subretinal fluid. CONCLUSIONS Solitary idiopathic choroiditis generally displays ultrasonographic solidity, hyperautofluorescence, and hyperreflectivity on IR imaging. On EDI OCT, the dome-shaped lesion arises from the sclera, outer choroid, or both and the overlying choroidal vasculature is thinned.
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Affiliation(s)
- Adrian T Fung
- Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Materin MA, Raducu R, Bianciotto C, Shields CL. Fundus autofluorescence and optical coherence tomography findings in choroidal melanocytic lesions. Middle East Afr J Ophthalmol 2011; 17:201-6. [PMID: 20844674 PMCID: PMC2934710 DOI: 10.4103/0974-9233.65489] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: To establish the characteristics of secondary retinal and retinal pigment epithelial (RPE) changes associated with the presence of choroidal melanoma and choroidal nevus as documented by optical coherence tomography (OCT) and fundus autofluorescence (FAF). Materials and Methods: PubMed review of major English publications examining the correlation between clinical characteristics of choroidal melanoma and nevus with OCT and FAF findings. Results: The intrinsic properties of choroidal melanoma, as well as overlying RPE changes, drusen, and lipofuscin are best characterized by FAF, while OCT is more sensitive for the identification of subretinal and intraretinal fluid as well as atrophy, degeneration, and photoreceptor loss in the neurosensory retina. Conclusions: Secondary retinal changes associated with choroidal melanocytic lesions can be documented by OCT and FAF. OCT-evident changes are observed more often with choroidal melanoma than choroidal nevus. OCT is better suited to identify the overlying retinal detachment and edema, even before these findings are clinically apparent. FAF is most useful in documenting the presence of lipofuscin, a finding that represents one of the important criteria in differentiating small choroidal melanoma from benign choroidal nevus.
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Affiliation(s)
- Miguel A Materin
- Ophthalmic Oncology Section, Department of Ophthalmology, Yale University School of Medicine, New Haven, CT, USA
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Ramasubramanian A, Shields CL, Mellen PL, Haji S, Harmon SA, Vemuganti GK, Shields JA. Autofluorescence of treated retinoblastoma. J AAPOS 2011; 15:167-72. [PMID: 21596295 DOI: 10.1016/j.jaapos.2010.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 11/24/2010] [Accepted: 12/24/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To describe the autofluorescent features of retinoblastomas after treatment. METHODS Standard fundus photography and autofluorescence (AF) photography (580 nm excitation, 695 nm barrier filter) were performed on 88 tumors of 61 patients. Clinical features were correlated with autofluorescent features. RESULTS The mean patient age at AF was 10.3 years. Of the 88 tumors, 5 (6%) were untreated, and 83 (94%) were treated. The untreated retinoblastomas showed hyperautofluorescence (hyperAF) at the site of calcification in all 5 cases (100%). The treated retinoblastomas showed intrinsic calcification in 54 cases (65%) and bright hyperAF at the site of calcification was detected in all cases. Of the 60 tumors with noncalcified remnant, the noncalcified portion was mildly hyperAF in 20 (33%), isoautofluorescence in 31 (52%), and mildly hypoautofluorescence (hypoAF) in 9 (15%). Surrounding retinal pigment epithelium hyperplasia appeared moderately hypoAF in 58 of 58 eyes (100%). Retinal pigment epithelium atrophy appeared mildly hyperAF in 29 (37%), isoautofluorescence in 33 (42%), and mildly hypoAF in 16 (21%). CONCLUSIONS AF of retinoblastoma generally shows bright hyperAF of the calcified portion and variable AF of the noncalcified portion. The AF of calcification in retinoblastoma was confirmed by fluorescent microscopy of unstained sections of retinoblastoma after enucleation.
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Abstract
PURPOSE The purpose of this study was to describe the autofluorescence (AF) features of choroidal hemangioma in 34 consecutive patients. METHODS Standard fundus photography and AF photography (580-nm excitation, 695-nm barrier filter) were performed on all patients. The clinical features were correlated with AF features. The main outcome measures were autofluorescence features of choroidal hemangioma (intrinsic AF) and overlying retinal pigment epithelium (extrinsic AF). RESULTS There were 27 eyes with circumscribed choroidal hemangioma (CCH) and 7 eyes with diffuse choroidal hemangioma (DCH). The mean patient age was 53 years for CCH and 15 years for DCH. Intrinsic AF of untreated CCH was generally iso-AF (n = 7, 58%) and for treated CCH was hypo-AF (n = 15, 100%). Extrinsic AF of CCH disclosed hyper-AF (orange pigment and fresh subretinal fluid) and hypo-AF (retinal pigment epithelium hyperplasia, fibrous metaplasia, and atrophy). Intrinsic AF of untreated DCH was generally hypo-AF (n = 2, 67%) and for treated DCH was hypo-AF (n = 3, 75%). Extrinsic AF of DCH was similar to CCH. CONCLUSION Choroidal hemangioma shows little intrinsic AF. Overlying orange pigment and fresh subretinal fluid show hyper-AF and retinal pigment epithelium hyperplasia and atrophy show hypo-AF.
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