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Verbeek S, Dalvin LA. Advances in multimodal imaging for diagnosis of pigmented ocular fundus lesions. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:218-233. [PMID: 37480939 PMCID: PMC10796850 DOI: 10.1016/j.jcjo.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 05/25/2023] [Accepted: 07/06/2023] [Indexed: 07/24/2023]
Abstract
Pigmented ocular fundus lesions can range from benign to malignant. While observation is reasonable for asymptomatic benign lesions, early recognition of tumours that are vision or life threatening is critical for long-term prognosis. With recent advances and increased accessibility of multimodal imaging, it is important that providers understand how to best use these tools to detect tumours that require early referral to subspecialty centres. This review aims to provide an overview of pigmented ocular fundus lesions and their defining characteristics using multimodal imaging. We cover the spectrum of pigmented ocular fundus lesions, including freckle and focal aggregates of normal or near-normal uveal melanocytes, retinal pigment epithelium (RPE) hyperplasia, congenital hypertrophy of the RPE, RPE hamartoma associated with familial adenomatous polyposis, congenital simple hamartoma of the RPE, combined hamartoma of the retina and RPE (congenital hypertrophy of the RPE), choroidal nevus, melanocytosis, melanocytoma, melanoma, adenoma, and RPE adenocarcinoma. We describe key diagnostic features using multimodal imaging modalities of ultra-widefield fundus photography, fundus autofluorescence, optical coherence tomography (OCT), enhanced-depth imaging OCT, ultrasonography, fluorescein angiography, indocyanine green angiography, and OCT angiography (OCTA), with particular attention to diagnostic features that could be missed on fundus examination alone. Finally, we review what is on the horizon, including applications of artificial intelligence. Through skilled application of current and emerging imaging technologies, earlier detection of sight- and life-threatening melanocytic ocular fundus tumours can lead to improved patient prognosis.
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Affiliation(s)
- Sara Verbeek
- Department of Ophthalmology, Mayo Clinic, Rochester, MN
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Gomel N, Goldstein M, Fung AT, Iovino C, Tatti F, Peiretti E, Habot-Wilner Z, Loewenstein A, Iglicki M, Zur D. Reply. Retina 2024; 44:e47-e48. [PMID: 38564803 DOI: 10.1097/iae.0000000000004112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Nir Gomel
- Ophthalmology Division, Tel Aviv Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michaella Goldstein
- Ophthalmology Division, Tel Aviv Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adrian T Fung
- Westmead and Central Clinical Schools, Specialty of Ophthalmology and Eye Health, The University of Sydney, Sydney, Australia
- Department of Ophthalmology, Faculty of Medicine, Health and Human Sciences, Macquarie University Hospital, Sydney, Australia
| | - Claudio Iovino
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Filippo Tatti
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy; and
| | - Enrico Peiretti
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy; and
| | - Zohar Habot-Wilner
- Ophthalmology Division, Tel Aviv Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Loewenstein
- Ophthalmology Division, Tel Aviv Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Matias Iglicki
- Private Retina Practice, University of Buenos Aires, Buenos Aires, Argentina
| | - Dinah Zur
- Ophthalmology Division, Tel Aviv Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Selvander M, Alexander J, Guenot D. Naevi Characterization Using Hyperspectral Imaging: A Pilot Study. Curr Eye Res 2024; 49:624-630. [PMID: 38407145 DOI: 10.1080/02713683.2024.2314602] [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: 09/10/2023] [Accepted: 01/29/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE The prevalence of choroidal naevi is common and has been found to be up to 10%. Little is known regarding the optical properties of choroidal naevi. A novel hyperspectral eye fundus camera was used to investigate choroidal naevi's optical density spectra in the retina. METHODS In an ophthalmology clinic setting, patients with choroidal naevi were included in the study. Visual acuity and pressure were tested. Following mydriatics, optical coherence tomography and fundus photography were taken as a reference, after which a hyperspectral image with 12 nm spectral resolution at 450-700 nm was taken. The optical density spectra was measured across the area of the naevus. RESULTS Nine patients with 11 naevi were examined. The visual acuity was not affected by any of the naevi. All the naevi were flat as measured either with the optical coherence tomography and/or on inspection, and only one naevi had a risk factor (orange pigmentation). The Wasserstein distance between the background and the naevi was higher at 695 nm compared to 555 nm (p = .002). The naevi could be grouped into three clusters based on the extracted optical density spectra. CONCLUSION Choroidal naevi are better visible in longer wavelengths compared to shorter wavelengths. This finding can be used to contour and follow choroidal naevi. Choroidal naevi expose different optical density spectra that can be grouped into three different clusters. One of these clusters has an optical density spectra resembling the absorption spectra of lipofuscin, which may indicate the content of this pigment.
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Affiliation(s)
- Madeleine Selvander
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
- Sundets Ögonläkare, Helsingborg, Sweden
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Dadzie AK, Iddir SP, Abtahi M, Ebrahimi B, Le D, Ganesh S, Son T, Heiferman MJ, Yao X. Colour fusion effect on deep learning classification of uveal melanoma. Eye (Lond) 2024:10.1038/s41433-024-03148-4. [PMID: 38773261 DOI: 10.1038/s41433-024-03148-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 04/23/2024] [Accepted: 05/10/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Reliable differentiation of uveal melanoma and choroidal nevi is crucial to guide appropriate treatment, preventing unnecessary procedures for benign lesions and ensuring timely treatment for potentially malignant cases. The purpose of this study is to validate deep learning classification of uveal melanoma and choroidal nevi, and to evaluate the effect of colour fusion options on the classification performance. METHODS A total of 798 ultra-widefield retinal images of 438 patients were included in this retrospective study, comprising 157 patients diagnosed with UM and 281 patients diagnosed with choroidal naevus. Colour fusion options, including early fusion, intermediate fusion and late fusion, were tested for deep learning image classification with a convolutional neural network (CNN). F1-score, accuracy and the area under the curve (AUC) of a receiver operating characteristic (ROC) were used to evaluate the classification performance. RESULTS Colour fusion options were observed to affect the deep learning performance significantly. For single-colour learning, the red colour image was observed to have superior performance compared to green and blue channels. For multi-colour learning, the intermediate fusion is better than early and late fusion options. CONCLUSION Deep learning is a promising approach for automated classification of uveal melanoma and choroidal nevi. Colour fusion options can significantly affect the classification performance.
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Affiliation(s)
- Albert K Dadzie
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL, 60607, USA
| | - Sabrina P Iddir
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL, 60612, USA
| | - Mansour Abtahi
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL, 60607, USA
| | - Behrouz Ebrahimi
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL, 60607, USA
| | - David Le
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL, 60607, USA
| | - Sanjay Ganesh
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL, 60612, USA
| | - Taeyoon Son
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL, 60607, USA
| | - Michael J Heiferman
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL, 60612, USA.
| | - Xincheng Yao
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL, 60607, USA.
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL, 60612, USA.
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5
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Gerrie SK, Rajani H, Branson HM, Lyons CJ, Marie E, Frayn CS, Hughes ECM, Navarro OM. Pediatric orbital lesions: ocular pathologies. Pediatr Radiol 2024; 54:876-896. [PMID: 38321238 DOI: 10.1007/s00247-024-05869-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/08/2024]
Abstract
Orbital pathologies can be broadly classified as ocular, extra-ocular soft-tissue (non-neoplastic and neoplastic), osseous, and traumatic. In part 1 of this orbital series, the authors will discuss the differential diagnosis and key imaging features of pediatric ocular pathologies. These include congenital and developmental lesions (microphthalmos, anophthalmos, persistent fetal vasculature, coloboma, morning glory disc anomaly, retinopathy of prematurity, Coats disease), optic disc drusen, infective and inflammatory lesions (uveitis, toxocariasis, toxoplasmosis), and ocular neoplasms (retinoblastoma, retinal hamartoma, choroidal melanoma, choroidal nevus). This pictorial review provides a practical approach to the imaging work-up of these anomalies with a focus on ocular US as the first imaging modality and additional use of CT and/or MRI for the evaluation of intracranial abnormalities. The characteristic imaging features of the non-neoplastic mimics of retinoblastoma, such as persistent fetal vasculature and Coats disease, are also highlighted.
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Affiliation(s)
- Samantha K Gerrie
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
- Department of Radiology, University of British Columbia, Vancouver, Canada.
| | - Heena Rajani
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Helen M Branson
- Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Christopher J Lyons
- Department of Ophthalmology, BC Children's Hospital, Vancouver, Canada
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Eman Marie
- Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, Hamilton, Canada
| | - Cassidy S Frayn
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Emily C M Hughes
- Department of Radiology, BC Children's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Oscar M Navarro
- Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, Canada
- Department of Medical Imaging, University of Toronto, Toronto, Canada
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Yeager LB, Kassotis A, Frank T, Li CY, Marr BP. A Review of Pediatric Ophthalmic Tumors. Pediatr Rev 2024; 45:119-131. [PMID: 38425168 DOI: 10.1542/pir.2023-006163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Tumors of the eye, orbit, and ocular adnexa can arise in the pediatric population. These entities can be both vision- and life-threatening and may be associated with systemic disease. Given their relative rarity, pediatricians must be aware of these conditions and understand what findings warrant immediate referral to an ophthalmologist for initiation of further testing. We aimed to review these conditions and highlight clinical features to promote awareness and expedite diagnosis. Tumors are subdivided into the following categories for review: anterior tumors of the eyelid and ocular surface, orbital tumors, and intraocular tumors.
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Affiliation(s)
- Lauren B Yeager
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
| | - Alexis Kassotis
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
| | - Tahvi Frank
- Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY
| | - Chloe Y Li
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
| | - Brian P Marr
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY
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Rossi A, Zeng Y, Rahimi M, Son T, Heiferman MJ, Gong C, Sun X, Soleimani M, Djalilian AR, Humayun MS, Zhou Q, Yao X. Integrating a Fundus Camera with High-Frequency Ultrasound for Precise Ocular Lesion Assessment. BIOSENSORS 2024; 14:127. [PMID: 38534234 DOI: 10.3390/bios14030127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 03/28/2024]
Abstract
Ultrasound A-scan is an important tool for quantitative assessment of ocular lesions. However, its usability is limited by the difficulty of accurately localizing the ultrasound probe to a lesion of interest. In this study, a transparent LiNbO3 single crystal ultrasound transducer was fabricated, and integrated with a widefield fundus camera to guide the ultrasound local position. The electrical impedance, phase spectrum, pulse-echo performance, and optical transmission spectrum of the ultrasound transducer were validated. The novel fundus camera-guided ultrasound probe was tested for in vivo measurement of rat eyes. Anterior and posterior segments of the rat eye could be unambiguously differentiated with the fundus photography-guided ultrasound measurement. A model eye was also used to verify the imaging performance of the prototype device in the human eye. The prototype shows the potential of being used in the clinic to accurately measure the thickness and echogenicity of ocular lesions in vivo.
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Affiliation(s)
- Alfa Rossi
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL 60607, USA
| | - Yushun Zeng
- Alfred E. Mann Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA 90089, USA
- USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Mojtaba Rahimi
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL 60607, USA
| | - Taeyoon Son
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL 60607, USA
| | - Michael J Heiferman
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Chen Gong
- Alfred E. Mann Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA 90089, USA
- USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Xin Sun
- Alfred E. Mann Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA 90089, USA
- USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Mohammad Soleimani
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Ali R Djalilian
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Mark S Humayun
- Alfred E. Mann Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA 90089, USA
- USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- USC Ginsburg Institute for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA
| | - Qifa Zhou
- Alfred E. Mann Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA 90089, USA
- USC Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
- USC Ginsburg Institute for Biomedical Therapeutics, University of Southern California, Los Angeles, CA 90033, USA
| | - Xincheng Yao
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL 60607, USA
- Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, IL 60612, USA
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8
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Roca-Cabau MA, Kumaran N, Asencio-Durán M, Pita-Ortiz I, Dabad Moreno JV. Pseudomelanoma diagnosis in a tertiary ophthalmologic centre in Spain. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00029-2. [PMID: 38387859 DOI: 10.1016/j.jcjo.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/22/2023] [Accepted: 01/29/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE To determine the types and frequency of lesions that can be misdiagnosed as choroidal or ciliary body melanomas (posterior uveal tract melanoma [PUM]). METHODS This is a retrospective, descriptive study examining data from patients referred to Hospital La Paz in Madrid with the diagnosis of possible PUM between January 2005 and March 2020. All patients referred for PUM were studied. In collaboration with an oncology-specialized ophthalmologic centre, each patient underwent a full ophthalmic examination, ultrasonography, and optical coherence tomography, with agreed clinical criteria used to differentiate melanomas from pseudomelanomas. RESULTS In our cohort of 715 patients, 48.9% had pseudomelanomas. Thirty-five different conditions were misdiagnosed as melanomas. The 5 most common conditions were choroidal nevus (40.5%), peripheral exudative hemorrhagic chorioretinopathy (12%), choroidal hemangioma (10.5%), choroidal metastasis (8%), and age-related macular degeneration (4%). CONCLUSIONS Altering the diagnosis and changing the treatment and prognosis for patients can be difficult for a referral centre. Herein we present the largest European cohort investigated and highlight the importance of identifying the correct diagnosis to prevent mistreatment and possible overtreatment. These misdiagnoses can have an emotional effect on patients and their families, which could be avoided with a correct diagnosis. We analyze the most common pseudomelanoma diagnoses to help physicians better diagnose patients in their care.
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Adusei SA, Sabeti S, Larson NB, Dalvin LA, Fatemi M, Alizad A. Quantitative Biomarkers Derived from a Novel, Contrast-Free Ultrasound, High-Definition Microvessel Imaging for Differentiating Choroidal Tumors. Cancers (Basel) 2024; 16:395. [PMID: 38254884 PMCID: PMC10814019 DOI: 10.3390/cancers16020395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 12/30/2023] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
Angiogenesis has an essential role in the de novo evolution of choroidal melanoma as well as choroidal nevus transformation into melanoma. Differentiating early-stage melanoma from nevus is of high clinical importance; thus, imaging techniques that provide objective information regarding tumor microvasculature structures could aid accurate early detection. Herein, we investigated the feasibility of quantitative high-definition microvessel imaging (qHDMI) for differentiation of choroidal tumors in humans. This new ultrasound-based technique encompasses a series of morphological filtering and vessel enhancement techniques, enabling the visualization of tumor microvessels as small as 150 microns and extracting vessel morphological features as new tumor biomarkers. Distributional differences between the malignant melanomas and benign nevi were tested on 37 patients with choroidal tumors using a non-parametric Wilcoxon rank-sum test, and statistical significance was declared for biomarkers with p-values < 0.05. The ocular oncology diagnosis was choroidal melanoma (malignant) in 21 and choroidal nevus (benign) in 15 patients. The mean thickness of benign and malignant masses was 1.70 ± 0.40 mm and 3.81 ± 2.63 mm, respectively. Six HDMI biomarkers, including number of vessel segments (p = 0.003), number of branch points (p = 0.003), vessel density (p = 0.03), maximum tortuosity (p = 0.001), microvessel fractal dimension (p = 0.002), and maximum diameter (p = 0.003) exhibited significant distributional differences between the two groups. Contrast-free HDMI provided noninvasive imaging and quantification of microvessels of choroidal tumors. The results of this pilot study indicate the potential use of qHDMI as a complementary tool for characterization of small ocular tumors and early detection of choroidal melanoma.
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Affiliation(s)
- Shaheeda A. Adusei
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, 200 1st St. SW, Rochester, MN 55905, USA (M.F.)
| | - Soroosh Sabeti
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, 200 1st St. SW, Rochester, MN 55905, USA (M.F.)
| | - Nicholas B. Larson
- Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, 200 1st St. SW, Rochester, MN 55905, USA
| | - Lauren A. Dalvin
- Department of Ophthalmology, Mayo Clinic College of Medicine and Science, 200 1st St. SW, Rochester, MN 55905, USA
| | - Mostafa Fatemi
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, 200 1st St. SW, Rochester, MN 55905, USA (M.F.)
| | - Azra Alizad
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, 200 1st St. SW, Rochester, MN 55905, USA (M.F.)
- Department of Radiology, Mayo Clinic College of Medicine and Science, 200 1st St. SW, Rochester, MN 55905, USA
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10
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Adams OE, Siddiqui Y, Simmons MA, Tang PH, Koozekanani DD. CHOROIDAL NEVUS ASSOCIATED WITH VITELLIFORM DEPOSITION IN A PATIENT WITH AUTOSOMAL DOMINANT BEST DYSTROPHY. Retin Cases Brief Rep 2024; 18:120-123. [PMID: 36240079 DOI: 10.1097/icb.0000000000001328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND/PURPOSE To describe the clinical, optical coherence tomography (OCT), fundus autofluorescence and ultrasound findings of a patient with a choroidal nevus actively exuding vitelliform material in the setting of autosomal dominant Best dystrophy (BD). METHODS The patient's clinical course was followed over time with ophthalmic examinations and multimodal imaging. RESULTS A 71-year-old male patient with BD was referred for evaluation of a choroidal nevus in the right eye. Dilated fundoscopic examination showed a small pigmented choroidal nevus in the temporal periphery. Over a 3-year period, the nevus developed progressive deposition of vitelliform material along its inferior border. Meanwhile, OCT and fundus photography showed only slight growth. Ultrasound showed no change in height; basal measurements were confounded by the increased vitelliform deposits. Genetic testing confirmed a heterozygous mutation in the BEST1 gene and electrophysiology was consistent with BD. CONCLUSIONS Dysfunction of the retinal pigment epithelium associated with BD may cause novel presentations of other conditions such as choroidal nevi. The implication for malignant transformation of a choroidal nevus associated with vitelliform deposit accumulation in this context is unknown.
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Affiliation(s)
- Olufemi E Adams
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota; and
| | - Yousuf Siddiqui
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota; and
| | - Michael A Simmons
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota; and
| | - Peter H Tang
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota; and
- VitreoRetinal Surgery, PLLC, Edina, Minnesota
| | - Dara D Koozekanani
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota; and
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11
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Iddir SP, Love J, Ma JS, Bryan JM, Ganesh S, Heiferman MJ, Yi D. Predicting Malignant Transformation of Choroidal Nevi Using Machine Learning. RESEARCH SQUARE 2023:rs.3.rs-3778562. [PMID: 38196619 PMCID: PMC10775400 DOI: 10.21203/rs.3.rs-3778562/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Objective This study aims to assess a machine learning (ML) algorithm using multimodal imaging to accurately identify risk factors for uveal melanoma (UM) and aid in the diagnosis of melanocytic choroidal tumors. Subjects and Methods This study included 223 eyes from 221 patients with melanocytic choroidal lesions seen at the eye clinic of the University of Illinois at Chicago between 01/2010 and 07/2022. An ML algorithm was developed and trained on ultra-widefield fundus imaging and B-scan ultrasonography to detect risk factors of malignant transformation of choroidal lesions into UM. The risk factors were verified using all multimodal imaging available from the time of diagnosis. We also explore classification of lesions into UM and choroidal nevi using the ML algorithm. Results The ML algorithm assessed features of ultra-widefield fundus imaging and B-scan ultrasonography to determine the presence of the following risk factors for malignant transformation: lesion thickness, subretinal fluid, orange pigment, proximity to optic nerve, ultrasound hollowness, and drusen. The algorithm also provided classification of lesions into UM and choroidal nevi. A total of 115 patients with choroidal nevi and 108 patients with UM were included. The mean lesion thickness for choroidal nevi was 1.6 mm and for UM was 5.9 mm. Eleven ML models were implemented and achieved high accuracy, with an area under the curve of 0.982 for thickness prediction and 0.964 for subretinal fluid prediction. Sensitivity/specificity values ranged from 0.900/0.818 to 1.000/0.727 for different features. The ML algorithm demonstrated high accuracy in identifying risk factors and differentiating lesions based on the analyzed imaging data. Conclusions This study provides proof of concept that ML can accurately identify risk factors for malignant transformation in melanocytic choroidal tumors based on a single ultra-widefield fundus image or B-scan ultrasound at the time of initial presentation. By leveraging the efficiency and availability of ML, this study has the potential to provide a non-invasive tool that helps to prevent unnecessary treatment, improve our ability to predict malignant transformation, reduce the risk of metastasis, and potentially save patient lives.
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Affiliation(s)
- Sabrina P Iddir
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago
| | - Jacob Love
- Department of Computer Science, University of Illinois at Chicago
| | - Jiechao Simon Ma
- Department of Biomedical Engineering, University of Illinois at Chicago
| | - John M Bryan
- Department of Ophthalmology, Northwestern University
| | - Sanjay Ganesh
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago
| | - Michael J Heiferman
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago
| | - Darvin Yi
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago
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12
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Qureshi MB, Lentz PC, Xu TT, White LJ, Olsen TW, Pulido JS, Dalvin LA. Choroidal Nevus Features Associated with Subspecialty Referral. Ophthalmol Retina 2023; 7:1097-1108. [PMID: 37517800 PMCID: PMC10823039 DOI: 10.1016/j.oret.2023.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To identify choroidal nevus features associated with referral to a retina or ocular oncology subspecialist. DESIGN Population-based retrospective cohort study. SUBJECTS Patients diagnosed with choroidal nevus. METHODS Population-based retrospective cohort study of residents of Olmsted County, Minnesota, with an incident diagnosis of choroidal nevus from January 1, 2006, to December 31, 2015 using the Rochester Epidemiology Project, a medical record linkage system. Tumor features and patient demographics associated with referral to a retina or ocular oncology subspecialist were assessed. Wilcoxon rank sum test, chi-square test, and Fisher exact test were used for statistical analysis. MAIN OUTCOME MEASURES Tumor features and patient demographics associated with referral to subspecialty care. RESULTS There were 826 incident diagnoses of choroidal nevus, of which 88 cases (11%) were referred, with highest level of referral being retina in 29 cases (33%) and ocular oncology in 59 cases (67%). None of the analyzed demographic features were associated with choroidal nevus referral to subspecialty care. Tumor features associated with referral (vs. not referred) included greater mean basal diameter (4.6 mm vs. 2.4 mm, P < 0.001), greater mean tumor thickness (0.7 mm vs. 0.1 mm, P < 0.001), greater distance to optic disc (6.9 mm vs. 3.4 mm, P = 0.02), halo around nevus (5.7% vs. 0.4%, P < 0.001), and drusen on OCT (51% vs. 25%, P = 0.002). Presence of orange pigment (8% vs. 0%, P = 0.14), subretinal fluid (9% vs. 2.5%, P = 0.09), and low internal reflectivity on A-scan (7.7% vs. 0%, P = 1.00) were not found more frequently in the subspecialty referral group. CONCLUSIONS Greater basal diameter and mean tumor thickness of choroidal nevus were associated with referral to retina or ocular oncology. However, several features associated with increased risk of malignant transformation were not associated with subspecialty referral. These findings highlight the importance of educating eye care providers about high-risk tumor features associated with choroidal nevus transformation to melanoma. In the primary eye care setting where not all multimodal imaging may be available, we encourage color photography and OCT with referral for any features of basal diameter > 5 mm, presence of subretinal fluid, or thickness too large for capture by enhanced-depth imaging OCT. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
| | - Paul C Lentz
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | - Timothy T Xu
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Launia J White
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
| | - Timothy W Olsen
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Jose S Pulido
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota; Wills Eye Hospital, Department of Translational Ophthalmology, Philadelphia, Pennsylvania
| | - Lauren A Dalvin
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
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13
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Crump RT, Khan A, Weis E. Costs associated with treating uveal melanoma are understudied. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:e240-e241. [PMID: 37488052 DOI: 10.1016/j.jcjo.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/12/2023] [Accepted: 07/03/2023] [Indexed: 07/26/2023]
Affiliation(s)
| | | | - Ezekiel Weis
- University of Calgary, Calgary, AB; University of Alberta, Edmonton, AB
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14
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Yao X, Dadzie A, Iddir S, Abtahi M, Ebrahimi B, Le D, Ganesh S, Son T, Heiferman M. Color Fusion Effect on Deep Learning Classification of Uveal Melanoma. RESEARCH SQUARE 2023:rs.3.rs-3399214. [PMID: 37986860 PMCID: PMC10659548 DOI: 10.21203/rs.3.rs-3399214/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
Background Reliable differentiation of uveal melanoma and choroidal nevi is crucial to guide appropriate treatment, preventing unnecessary procedures for benign lesions and ensuring timely treatment for potentially malignant cases. The purpose of this study is to validate deep learning classification of uveal melanoma and choroidal nevi, and to evaluate the effect of color fusion options on the classification performance. Methods A total of 798 ultra-widefield retinal images of 438 patients were included in this retrospective study, comprising 157 patients diagnosed with UM and 281 patients diagnosed with choroidal nevus. Color fusion options, including early fusion, intermediate fusion and late fusion, were tested for deep learning image classification with a convolutional neural network (CNN). Specificity, sensitivity, F1-score, accuracy, and the area under the curve (AUC) of a receiver operating characteristic (ROC) were used to evaluate the classification performance. The saliency map visualization technique was used to understand the areas in the image that had the most influence on classification decisions of the CNN. Results Color fusion options were observed to affect the deep learning performance significantly. For single-color learning, the red color image was observed to have superior performance compared to green and blue channels. For multi-color learning, the intermediate fusion is better than early and late fusion options. Conclusion Deep learning is a promising approach for automated classification of uveal melanoma and choroidal nevi, and color fusion options can significantly affect the classification performance.
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15
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Oyemade KA, Xu TT, Lopez Dominguez J, Dumbrava MG, Hodge DO, White LJ, Dalvin LA. Population-based incidence of intraocular tumours in Olmsted County, Minnesota. Br J Ophthalmol 2023; 107:1369-1376. [PMID: 35450938 PMCID: PMC10350913 DOI: 10.1136/bjophthalmol-2021-320682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 04/12/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To determine population-based incidence of intraocular tumours in Olmsted County, Minnesota. METHODS Record review of the Rochester Epidemiology Project medical record linkage system from 1 January 2006 to 31 December 2015 for patient demographics, tumour type by clinical diagnosis and presence or absence of confirmation by histopathology. The incidence rate of any intraocular tumour and of each tumour type was calculated per million person-years. Poisson regression analysis was used to analyse changes in incidence over time. RESULTS There were 948 patients diagnosed with intraocular tumours resulting in an age-adjusted and sex-adjusted incidence rate of 727.5 per million (95% CI: 680.8 to 774.2, p<0.05). Most tumours were benign (953, 98%). Of the benign lesions, melanocytic lesions were the majority (942, 97%), with adjusted incidence rates of 646.9 (95% CI: 602.8 to 691.1) for choroidal nevus and 55.8 (95% CI: 43.2 to 64.8) for iris nevus. Malignant lesions were rare (16, 2%) with 13 cases of choroidal melanoma and 1 case each of iris melanoma, retinal leukaemic infiltration and metastasis. The adjusted incidence rate for choroidal melanoma was 7.1 (95% CI: 2.5 to 11.8). CONCLUSION In a population-based setting, most intraocular tumours are benign and melanocytic. Although malignant lesions are less common, it is important to remain vigilant with appropriate monitoring given the potential for vision loss and life-threatening malignancy.
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Affiliation(s)
| | - Timothy T Xu
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - David O Hodge
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, USA
| | - Launia J White
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, USA
| | - Lauren A Dalvin
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
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16
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Weber C, Herwig-Carl MC, Boeker A, Holz FG, Liegl R. [Transformation of a choroidal nevus into a choroidal melanoma after decades]. DIE OPHTHALMOLOGIE 2023; 120:841-846. [PMID: 36229705 DOI: 10.1007/s00347-022-01740-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/30/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Constance Weber
- Klinik für Augenheilkunde, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Martina C Herwig-Carl
- Klinik für Augenheilkunde, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
- Ophthalmopathologisches Labor, Klinik für Augenheilkunde, Universitätsklinikum Bonn, Bonn, Deutschland
- Centrum für Integrierte Onkologie (CIO), Universitätsklinikum Bonn, Bonn, Deutschland
| | - Alexander Boeker
- Augenklinik, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Frank G Holz
- Klinik für Augenheilkunde, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
- Centrum für Integrierte Onkologie (CIO), Universitätsklinikum Bonn, Bonn, Deutschland
| | - Raffael Liegl
- Klinik für Augenheilkunde, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
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17
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Azzolini C, Di Nicola M, Pozzo Giuffrida F, Cappelli F, Bellina C, Viola F, Chelazzi P. Retromode Scanning Laser Ophthalmoscopy for Choroidal Nevi: A Preliminary Study. Life (Basel) 2023; 13:1253. [PMID: 37374036 DOI: 10.3390/life13061253] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/14/2023] [Accepted: 05/18/2023] [Indexed: 06/29/2023] Open
Abstract
The purpose of the present study was to document pathological findings on retromode imaging in choroidal nevi and evaluate its diagnostic validity, using the confocal scanning laser ophthalmoscope Nidek Mirante (cSLO). A total of 41 choroidal nevi from 41 patients were included. All patients underwent multicolor fundus (mCF), infrared reflectance (IR), green fundus autofluorescence (FAF), dark-field (DF) and retromode (RM) imaging and optical coherence tomography (OCT) scans. We investigated retromode images to evaluate choroidal nevus features by comparing the results with those of mCF, IR, FAF, DF and OCT. In 100% of available images, retromode scanning laser ophthalmoscopy was able to detect choroidal nevi with a characteristic "hypo-retro-reflective" pattern, even the cases not visible on mCF, IR and FAF images. It also made it possible to delineate the margins of lesions with the highest rate of sharpness and accuracy among the imaging modalities examined. These findings seem to demonstrate how RM-SLO is an innovative diagnostic tool to detect and follow up choroidal nevi in a fast, reliable and non-invasive way.
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Affiliation(s)
- Claudia Azzolini
- Department of Ophthalmology, Istituto Clinico Città Studi, 20131 Milan, Italy
| | - Maura Di Nicola
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami 33136, FL, USA
| | - Francesco Pozzo Giuffrida
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Ophthalmological Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Francesca Cappelli
- Department of Ophthalmology, Istituto Clinico Città Studi, 20131 Milan, Italy
| | - Claudia Bellina
- Department of Ophthalmology, Istituto Clinico Città Studi, 20131 Milan, Italy
| | - Francesco Viola
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Ophthalmological Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Paolo Chelazzi
- Department of Ophthalmology, Istituto Clinico Città Studi, 20131 Milan, Italy
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18
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Nhari M, Thariat J, Kodjikian L, Chacun S, Nguyen AM, Rosier L, Herault J, Salleron J, Mathis T. Visual outcomes of macular melanocytic lesions after early or delayed proton beam therapy. Graefes Arch Clin Exp Ophthalmol 2023:10.1007/s00417-023-05981-x. [PMID: 36729331 DOI: 10.1007/s00417-023-05981-x] [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: 06/16/2022] [Revised: 12/22/2022] [Accepted: 01/13/2023] [Indexed: 02/03/2023] Open
Abstract
PURPOSE During their initial management, some macular melanocytic lesions can be closely monitored to wait for a documented growth before advocating a treatment by irradiation. However, the visual outcomes of this strategy have not yet been assessed. This study compares the visual outcomes of macular melanocytic lesions that underwent delayed proton beam therapy (PBT) after an initial observation to those treated early. METHODS A total of 162 patients with suspicious melanocytic lesions whose margins were located within 3 mm of the fovea were recruited from two French ocular oncology centers. RESULTS Overall, 82 patients treated with PBT within 4 months after the initial visit (early PBT group) were compared to 24 patients treated with delayed PBT (delayed PBT group) and 56 patients not treated with PBT (observation group). Visual acuity was not significantly different between baseline and last visit in the observation group (p = 0.325). Between baseline and last visit, the median [IQR] loss in visual acuity was significant in both the early (0.7 [0.2; 1.8], p < 0.001) and the delayed (0.5 [0.2; 1.5], p < 0.001) PBT groups. After irradiation, there was no significant difference between the early and delayed PBT groups for visual loss (p = 0.575), diameter reduction (p = 0.190), and thickness lowering (p = 0.892). In multivariate analysis, history of diabetes mellitus and Bruch's membrane rupture remained significantly associated with greater visual loss (p = 0.036 and p = 0.002, respectively). CONCLUSION For small lesions in which there is no clear diagnosis of malignant melanoma, an initial close monitoring to document tumor growth does not impact visual prognosis, despite the potential complications associated with the untreated tumor. However, the survival should remain the main outcome of the treatment of these lesions.
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Affiliation(s)
- Maxime Nhari
- Service d'Ophtalmologie, Hôpital Universitaire de La Croix-Rousse, Hospices Civils de Lyon, 103, Grande Rue de La Croix-Rousse, 69317cedex 04, Lyon, France
| | - Juliette Thariat
- Laboratoire de Physique Corpusculaire / IN2P3-CNRS UMR 6534 - ARCHADE, Unicaen - Université de Normandie, 14000, Caen, France
| | - Laurent Kodjikian
- Service d'Ophtalmologie, Hôpital Universitaire de La Croix-Rousse, Hospices Civils de Lyon, 103, Grande Rue de La Croix-Rousse, 69317cedex 04, Lyon, France.,UMR 5510 MATEIS, CNRS, INSA Lyon, Université Lyon 1, 69100, Villeurbanne, France
| | - Samuel Chacun
- Service d'Ophtalmologie, Hôpital Universitaire de La Croix-Rousse, Hospices Civils de Lyon, 103, Grande Rue de La Croix-Rousse, 69317cedex 04, Lyon, France
| | - Anh-Minh Nguyen
- Service d'Ophtalmologie, Hôpital Universitaire de La Croix-Rousse, Hospices Civils de Lyon, 103, Grande Rue de La Croix-Rousse, 69317cedex 04, Lyon, France
| | - Laurence Rosier
- Centre Ophtalmologique Rétine Galien, 33000, Bordeaux, France
| | - Joël Herault
- Service de Radiothérapie, Centre Antoine Lacassagne, 06000, Nice, France
| | - Julia Salleron
- Cellule Data Biostatistique, Institut de Cancérologie de Lorraine, 54000, Nancy, France
| | - Thibaud Mathis
- Service d'Ophtalmologie, Hôpital Universitaire de La Croix-Rousse, Hospices Civils de Lyon, 103, Grande Rue de La Croix-Rousse, 69317cedex 04, Lyon, France. .,UMR 5510 MATEIS, CNRS, INSA Lyon, Université Lyon 1, 69100, Villeurbanne, France.
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19
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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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20
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Maltsev DS, Kulikov AN, Vasiliev AS, Shapovalova ED, Chhablani J. Prevalence of choroidal nevi in patients with central serous chorioretinopathy. Ther Adv Ophthalmol 2023; 15:25158414231189080. [PMID: 37528899 PMCID: PMC10387679 DOI: 10.1177/25158414231189080] [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: 03/04/2023] [Accepted: 06/27/2023] [Indexed: 08/03/2023] Open
Abstract
Background A number of articles report the association of polypoidal lesions and choroidal nevi; however, the relationship between choroidal nevi and pachychoroidal disorders has not been studied. Objectives To study the prevalence of choroidal nevi in central serous chorioretinopathy (CSCR) patients and to elucidate potential differences in the clinical characteristics of CSCR in patients with and without choroidal nevi. Design Case-control study. Methods This study included a retrospective analysis of medical records and multimodal imaging data of CSCR patients and a prospective evaluation of the prevalence of the choroidal nevi in age- and sex-matched healthy controls. All participants received comprehensive ophthalmic examination and multimodal imaging including infrared scanning laser ophthalmoscopy in dark-field mode to detect choroidal nevi in the central 40° × 60° region. Results A total of 199 CSCR patients (160 males and 39 females, 47.9 ± 9.4 years) and 184 age-matched healthy individuals (139 males and 45 females, 44.8 ± 12.5 years) were included. Choroidal nevi were detected in 24 (12.1%) CSCR patients and 10 (5.4%) healthy controls (p = 0.01). CSCR patients with choroidal nevi had statistically significantly higher subfoveal choroidal thickness, lower best-corrected visual acuity, and lower central retinal thickness (p < 0.05) than CSCR patients without choroidal nevi. The odds ratio for the presence of chronic CSCR in patients with choroidal nevi was 27.0 (95% CI: 3.1-231.9, p = 0.003). Conclusion The prevalence of choroidal nevi among patients with CSCR is higher than in age- and sex-matched healthy population. Choroidal nevi may be associated with chronic CSCR.
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Affiliation(s)
| | - Alexey N. Kulikov
- Department of Ophthalmology, Military Medical Academy, St. Petersburg, Russia
| | | | | | - Jay Chhablani
- University of Pittsburgh, UPMC Eye Center, Pittsburgh, PA, USA
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21
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Valmaggia P, Friedli P, Hörmann B, Kaiser P, Scholl HPN, Cattin PC, Sandkühler R, Maloca PM. Feasibility of Automated Segmentation of Pigmented Choroidal Lesions in OCT Data With Deep Learning. Transl Vis Sci Technol 2022; 11:25. [PMID: 36156729 PMCID: PMC9526362 DOI: 10.1167/tvst.11.9.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the feasibility of automated segmentation of pigmented choroidal lesions (PCLs) in optical coherence tomography (OCT) data and compare the performance of different deep neural networks. Methods Swept-source OCT image volumes were annotated pixel-wise for PCLs and background. Three deep neural network architectures were applied to the data: the multi-dimensional gated recurrent units (MD-GRU), the V-Net, and the nnU-Net. The nnU-Net was used to compare the performance of two-dimensional (2D) versus three-dimensional (3D) predictions. Results A total of 121 OCT volumes were analyzed (100 normal and 21 PCLs). Automated PCL segmentations were successful with all neural networks. The 3D nnU-Net predictions showed the highest recall with a mean of 0.77 ± 0.22 (MD-GRU, 0.60 ± 0.31; V-Net, 0.61 ± 0.25). The 3D nnU-Net predicted PCLs with a Dice coefficient of 0.78 ± 0.13, outperforming MD-GRU (0.62 ± 0.23) and V-Net (0.59 ± 0.24). The smallest distance to the manual annotation was found using 3D nnU-Net with a mean maximum Hausdorff distance of 315 ± 172 µm (MD-GRU, 1542 ± 1169 µm; V-Net, 2408 ± 1060 µm). The 3D nnU-Net showed a superior performance compared with stacked 2D predictions. Conclusions The feasibility of automated deep learning segmentation of PCLs was demonstrated in OCT data. The neural network architecture had a relevant impact on PCL predictions. Translational Relevance This work serves as proof of concept for segmentations of choroidal pathologies in volumetric OCT data; improvements are conceivable to meet clinical demands for the diagnosis, monitoring, and treatment evaluation of PCLs.
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Affiliation(s)
- Philippe Valmaggia
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland.,Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland.,Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | | | | | | | - Hendrik P N Scholl
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland.,Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - Philippe C Cattin
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Robin Sandkühler
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Peter M Maloca
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland.,Department of Ophthalmology, University Hospital Basel, Basel, Switzerland.,Moorfields Eye Hospital NHS Foundation Trust, London, EC1V 2PD, UK
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22
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Importance of Optical Coherence Tomography and Optical Coherence Tomography Angiography in the Imaging and Differentiation of Choroidal Melanoma: A Review. Cancers (Basel) 2022; 14:cancers14143354. [PMID: 35884415 PMCID: PMC9316780 DOI: 10.3390/cancers14143354] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/03/2022] [Accepted: 07/09/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Choroidal melanoma is a highly malignant intraocular neoplasm. It is the most prevalent intraocular tumor in adults and it derives from melanocytes; the liver is the most common site of its metastases. An early and noninvasive diagnosis is essential to enhance patients’ chances for early treatment. The OCT and OCTA-A are a noninvasive and noncontact methods used in the diagnostic process and support therapeutic decisions during control visits. These devices allow for detection and the real-time imaging of choroidal melanoma and its differentiation from metastasis and choroidal nevi. In addition to analyzing the currently utilized OCT and OCT-A methods, this review describes also the anatomy and imaging of specific vascular layers of the eye. Abstract Choroidal melanoma requires reliable and precise clinical examination and diagnosis to differentiate it from benign choroidal nevi. To achieve accurate diagnosis, as well as monitoring the progression of disease, various imaging modalities are used, including non-invasive optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). This review begins with a historical account of the development of OCT and OCTA and the methods of generation of images. This outlines the understanding of what OCT/OCTA images show, as well as how image artifacts arise. The anatomy and imaging of specific vascular layers of the eye are introduced. Then, anatomical aspects of choroidal melanoma, its diagnosis and differentiation from metastasis, and choroidal nevi are presented. The purpose of this review is to critically evaluate application of OCT and OCTA in the diagnosis of choroidal melanoma.
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23
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Beasley AB, Chen FK, Isaacs TW, Gray ES. Future perspectives of uveal melanoma blood based biomarkers. Br J Cancer 2022; 126:1511-1528. [PMID: 35190695 PMCID: PMC9130512 DOI: 10.1038/s41416-022-01723-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 01/15/2022] [Accepted: 01/27/2022] [Indexed: 01/06/2023] Open
Abstract
Uveal melanoma (UM) is the most common primary intraocular malignancy affecting adults. Despite successful local treatment of the primary tumour, metastatic disease develops in up to 50% of patients. Metastatic UM carries a particularly poor prognosis, with no effective therapeutic option available to date. Genetic studies of UM have demonstrated that cytogenetic features, including gene expression, somatic copy number alterations and specific gene mutations can allow more accurate assessment of metastatic risk. Pre-emptive therapies to avert metastasis are being tested in clinical trials in patients with high-risk UM. However, current prognostic methods require an intraocular tumour biopsy, which is a highly invasive procedure carrying a risk of vision-threatening complications and is limited by sampling variability. Recently, a new diagnostic concept known as "liquid biopsy" has emerged, heralding a substantial potential for minimally invasive genetic characterisation of tumours. Here, we examine the current evidence supporting the potential of blood circulating tumour cells (CTCs), circulating tumour DNA (ctDNA), microRNA (miRNA) and exosomes as biomarkers for UM. In particular, we discuss the potential of these biomarkers to aid clinical decision making throughout the management of UM patients.
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Affiliation(s)
- Aaron B Beasley
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Centre for Precision Health, Edith Cowan University, Joondalup, WA, Australia
| | - Fred K Chen
- Centre for Ophthalmology and Visual Sciences (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, WA, Australia
- Department of Ophthalmology, Royal Perth Hospital, Perth, WA, Australia
- Department of Ophthalmology, Perth Children's Hospital, Perth, WA, Australia
| | - Timothy W Isaacs
- Centre for Ophthalmology and Visual Sciences (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, WA, Australia
- Department of Ophthalmology, Royal Perth Hospital, Perth, WA, Australia
- Perth Retina, West Leederville, WA, Australia
| | - Elin S Gray
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
- Centre for Precision Health, Edith Cowan University, Joondalup, WA, Australia.
- Centre for Ophthalmology and Visual Sciences (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, WA, Australia.
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Neerukonda VK, Kim IK, Stagner AM. Primary vitreoretinal involvement and immunopositivity for BRAFV600E help distinguish metastatic from primary intraocular melanoma: a detailed histopathologic study of metastatic cutaneous melanoma to the eye. Histopathology 2022; 80:1061-1070. [PMID: 35275414 DOI: 10.1111/his.14640] [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: 12/28/2021] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the clinicopathologic characteristics of metastatic cutaneous melanoma to the eye and identify potential distinguishing characteristics from the more common primary uveal melanoma; particularly, tumour location within the eye, cytomorphology and immunohistochemical/specific molecular genetic features. METHODS A retrospective observational case series using surgical enucleation and diagnostic vitrectomy cytologic specimens from seven patients with suspected intraocular melanoma, eventually diagnosed as metastatic melanoma, was conducted. Haematoxylin and eosin-stained sections of tumour and immunohistochemical (IHC) stains for BRAFV600E and Ki-67 were critically reviewed; BAP1 IHC was also evaluated in cases where additional tissue was available. Clinical imaging studies and medical records were reviewed. RESULTS The majority of patients (86%) with metastatic melanoma have primary vitreoretinal (not uveal) involvement and epithelioid, highly malignant cytomorphology (100%); many (50%) harbour BRAFV600E mutations, a finding not seen in large cohorts of primary uveal melanoma. CONCLUSIONS Characteristics favouring or defining metastatic intraocular melanoma over primary uveal melanoma include high-grade epithelioid cytology, predominant involvement of the vitreous cavity and/or retina, and presence of positive immunostaining for BRAFV600E.
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Affiliation(s)
- Vamsee K Neerukonda
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Ivana K Kim
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
- Vitreoretinal Surgery Service, Massachusetts Eye and Ear, Boston, MA, USA
| | - Anna M Stagner
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear, Boston, MA, USA
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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25
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Eye-specific quantitative dynamic contrast-enhanced MRI analysis for patients with intraocular masses. MAGMA (NEW YORK, N.Y.) 2022; 35:311-323. [PMID: 34643852 PMCID: PMC8995252 DOI: 10.1007/s10334-021-00961-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/30/2021] [Accepted: 09/20/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Dynamic contrast enhanced (DCE)-MRI is currently not generally used for intraocular masses as lesions are small, have an inhomogeneous T1 and the eye is prone to motion. The aim of this paper is to address these eye-specific challenges, enabling accurate ocular DCE-MRI. MATERIALS & METHODS DCE-MRI of 19 uveal melanoma (UM) patients was acquired using a fat-suppressed 3D spoiled gradient echo sequence with TWIST (time-resolved angiography with stochastic trajectories sequence). The analysis consisted of a two-step registration method to correct for both head and eye motion. A T1 map was calculated to convert signal intensities to concentrations. Subsequently, the Tofts model was fitted voxel wise to obtain Ktrans and ve. RESULTS Registration significantly improved the concentration curve quality (p < 0.001). The T1 of melanotic lesions was significantly lower than amelanotic lesions (888 ms vs 1350 ms, p = 0.03). The average achieved B1+ in the lesions was 91%. The average Ktrans was 0.46 min-1 (range 0.13-1.0) and the average ve was 0.22 (range 0.10-0.51). CONCLUSION Using this eye-specific analysis, DCE of intraocular masses is possible which might aid in the diagnosis, prognosis and follow-up of UM.
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Mobile Telemedicine Screening for Diabetic Retinopathy Using Nonmydriatic Fundus Photographs in Burgundy: 11 Years of Results. J Clin Med 2022; 11:jcm11051318. [PMID: 35268409 PMCID: PMC8911379 DOI: 10.3390/jcm11051318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 11/17/2022] Open
Abstract
We analyzed the results of mobile screening for diabetic retinopathy (DR) using retinal photographs, comparing these results between rural and periurban areas, and before and after the first national COVID-19 pandemic lockdown. The Burgundy Union Régionale des Professionnels de Santé (URPS) has organized an annual DR screening since 2004. The examination, performed by an orthoptist, consisted of taking the patient's history, intraocular pressure measurement, and taking retinal photographs. After remote transmission, the examinations were interpreted by participating ophthalmologists at the Dijon University Hospital. In September 2016, the screening was open to periurban townships. In 11 years, 10,220 patients were screened: 1,420 patients (13.9%) had DR of any type, with an average age of 68.5 (±11.3) years, and 59.2% were men. These patients had a statistically significantly higher glycated hemoglobin level (7.4% vs. 7.0%) and a longer duration of diabetes (13.8 vs. 9.3 years) than patients without DR. When comparing rural and periurban areas and periods before and after the beginning of the COVID-19 pandemic, we did not find any significant difference in the screening results. The results of this study are in line with the average findings of similar studies comparing screening strategies for DR. The early detection of DR can benefit from mobile telemedicine screening, identifying a considerable number of patients at an elevated risk, especially in rural areas where access to ophthalmological care is limited.
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Abstract
Optical coherence tomography (OCT) is widely applied in diagnosis and management of retina diseases particularly macular diseases in adult retina practices. However, it has been under-utilized in pediatric retinal diseases especially in neonates and infants. Utilization of OCT in primary macular diseases in this age group is also uncommon and is less reported. Challenges involved in image acquisition and limitations with available devices technique can explain the limited research and accurate data availability in the literature in this field. Purpose of this review article is to summarize the use of OCT and its importance in various infantile retinal pathologies such as vascular diseases, tumors, retinal dystrophies, and optic nerve pathologies with primary focus on neonates and infants, along with infant choroid. In addition, we also discuss about future directions including OCT angiography for infants.
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Affiliation(s)
- Sushma Jayanna
- Consultant Ophthalmologist, Department of Srimathi Kannuri Santhamma Center of Vitreoretinal Eye Disease, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Subhadra Jalali
- Consultant Ophthalmologist, Department of Srimathi Kannuri Santhamma Center of Vitreoretinal Eye Disease, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Tapas R Padhi
- Consultant Ophthalmologist, Department of Retina and Vitreous, Mithu Tulasi Chanrai Campus, Bhubaneswar, LV Prasad Eye Institute, India
| | - Komal Agarwal
- Consultant Ophthalmologist, Department of Srimathi Kannuri Santhamma Center of Vitreoretinal Eye Disease, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Jay Chhablani
- University of Pittsburgh, UPMC Eye Center, Pittsburgh, PA, USA
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28
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Tanke LB, Leske DA, Dalvin LA. Conversion Factor for B-Scan Ultrasound Measurement of Intraocular Tumors With and Without the Sclera. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1911-1917. [PMID: 33274784 DOI: 10.1002/jum.15575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/13/2020] [Accepted: 10/25/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To investigate the relationship between choroidal nevus and melanoma thickness measured with or without the sclera included by B-scan ultrasound and to present a simple conversion formula. METHODS Medical records were retrospectively reviewed for choroidal nevus or melanoma evaluated at the Mayo Clinic in Rochester, Minnesota, with B-scan ultrasound between February 4, 2004, and April 23, 2020. Charts were retrospectively reviewed for high-quality B-scan images in which the ultrasound transducer was perpendicular to the lesion, measuring the tumor thickness without the sclera included. Measurements were repeated with the sclera included for each patient. Univariate and multiple linear regression analyses were performed to identify factors correlated with scleral thickness. RESULTS There were 201 tumors included in the study, with a mean patient age ± SD of 61 ± 14 years, largest tumor basal diameter of 11.8 ± 4.8 mm, tumor thickness without the sclera included of 3.72 ± 2.7 mm, and thickness with the sclera included of 4.54 ± SD 2.8 mm. On the univariate analysis, factors associated with perceived scleral thickness by B-scan ultrasound included age (P < .001), tumor thickness (P < .001), and basal diameter (P = .06). On the multivariate analysis, factors associated with perceived scleral thickness included age and tumor thickness (P < .001) for all tumors and for the subset of 141 tumors with a thickness of 2 mm or greater (P < .001). For tumors of 2 mm or greater in thickness, perceived scleral thickness by ultrasound can be estimated by the formula 0.00495(patient age) + 0.02451(tumor thickness without the sclera) + 0.42549. CONCLUSIONS We present a simple formula for converting between B-scan ultrasound measurements of choroidal nevus and melanoma measuring 2 mm or greater in thickness with and without the sclera included.
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Affiliation(s)
- Laurel B Tanke
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - David A Leske
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lauren A Dalvin
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
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Brovkina AF, Stoyukhina AS, Musatkina IV. [Transformation of choroidal nevus into melanoma]. Vestn Oftalmol 2021; 137:5-17. [PMID: 34410051 DOI: 10.17116/oftalma20211370415] [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: 11/17/2022]
Abstract
The risk of choroidal melanoma developing from choroidal nevus (CN) varies in range of 0.78-7%. Absence of a common terminology and distinct diagnostic criteria characterizing small melanoma de novo and unusual CN often complicates treatment choice and patient prognosis. PURPOSE To study the clinical features and the role of visualization methods in the diagnosis of CN transformation into melanoma. MATERIAL AND METHODS The study analyzes the clinical picture and visualization results of 11 patients with initial diagnosis of «choroidal nevus» (n=3) and «suspicious choroidal nevus» (n=8). RESULTS AND DISCUSSION Examination and continued observation revealed 7 patients to have melanoma that had developed from CN (2 of them confirmed with histological studies). The time before CN transformed into melanoma varied between 4 and 13 years, with median 5 [4; 12] years. Two patients were diagnosed with primary melanoma (melanoma de novo), two other patients - with suspicious CN. In progressive CN transforming into melanoma, visual impairments occurred between 6 months and 13 years in 6 out of 7 patients. Initial prominence of suspicious CN at the first visit was 1.9±0.68 mm (0.9 mm to 2.67 mm). The characteristic features of suspicious CN transforming into initial melanoma are: 1) asymmetric shape of the edges of expanded choroidal complex; 2) presence of areas of damaged choriocapillaris layer, direct and indirect signs of loss of integrity of the Bruch's membrane; 3) areas of accumulation of moderately hyperreflective subretinal exudate; 4) presence of intraretinal hyperreflective inclusions. The signs distinguishing primary choroidal melanoma from melanoma that had developed from CN are: 1) absence of areas with tomography pattern characteristic of nevi; 2) more pronounced asymmetry of the shape of edges, compared to melanoma developed from CN; 3) presence of cysts in larger tumors, compared to melanoma developed from CN. CONCLUSION All patients with CN should be regularly followed up by an ophthalmologist.
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Affiliation(s)
- A F Brovkina
- Russian Medical Academy of Postgraduate Education, Moscow, Russia
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Foti PV, Travali M, Farina R, Palmucci S, Spatola C, Raffaele L, Salamone V, Caltabiano R, Broggi G, Puzzo L, Russo A, Reibaldi M, Longo A, Vigneri P, Avitabile T, Ettorre GC, Basile A. Diagnostic methods and therapeutic options of uveal melanoma with emphasis on MR imaging-Part I: MR imaging with pathologic correlation and technical considerations. Insights Imaging 2021; 12:66. [PMID: 34080069 PMCID: PMC8172816 DOI: 10.1186/s13244-021-01000-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/21/2021] [Indexed: 12/11/2022] Open
Abstract
Uveal melanoma is a malignant neoplasm that derives from pigmented melanocytes of the uvea and involves, in order of decreasing prevalence, the choroid, ciliary body and iris. Its prognosis is related to histopathologic and genetic features, tumor size and location, extraocular extension. The diagnosis is fundamentally based on clinical evaluation (ophthalmoscopy, biomicroscopy) and ultrasonography. MRI is useful in case of untransparent lens or subretinal effusion. Moreover, MRI has a significant role to confirm the diagnosis, in the evaluation of the local extent of the disease with implications for treatment planning, and in the follow-up after radiotherapy treatment. Uveal melanoma can show different morphologic features (lentiform, dome or mushroom shape) and often determines retinal detachment. MR appearance of uveal melanoma mainly depends on the melanin content. Uveal melanoma typically displays high signal intensity on T1-weighted images and low signal intensity on T2-weighted images. Nevertheless, imaging appearance may be variable based on the degree of pigmentation and the presence of areas of necrosis or cavitation. Differential diagnosis includes other uveal lesions. The radiologists and in particular MRI play a significant role in the clinical management of uveal melanoma. The purpose of this pictorial review is to provide the radiologists with awareness about diagnostic methods and therapeutic options of uveal melanoma. In the present first section we summarize the MR anatomy of the eye and describe ophthalmological and radiological imaging techniques to diagnose uveal melanomas, with emphasis on the role of MR imaging. Additionally, we review MR imaging appearance of uveal melanomas.
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Affiliation(s)
- Pietro Valerio Foti
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia" - Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy.
| | - Mario Travali
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia" - Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Renato Farina
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia" - Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Stefano Palmucci
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia" - Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Corrado Spatola
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia" - Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Luigi Raffaele
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia" - Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Vincenzo Salamone
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia" - Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Rosario Caltabiano
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia" - Section of Anatomic Pathology, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Giuseppe Broggi
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia" - Section of Anatomic Pathology, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Lidia Puzzo
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia" - Section of Anatomic Pathology, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Andrea Russo
- Department of Ophthalmology, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Michele Reibaldi
- Department of Ophthalmology, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Antonio Longo
- Department of Ophthalmology, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Paolo Vigneri
- Department of Clinical and Experimental Medicine, Center of Experimental Oncology and Hematology, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Teresio Avitabile
- Department of Ophthalmology, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Giovani Carlo Ettorre
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia" - Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
| | - Antonio Basile
- Department of Medical Surgical Sciences and Advanced Technologies "G.F. Ingrassia" - Radiology I Unit, University Hospital Policlinico "G. Rodolico-San Marco", Via Santa Sofia 78, 95123, Catania, Italy
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Venkatesh R, Reddy N, Cherry JP, Pereira A, Yadav NK, Chhablani J. Bilateral idiopathic choroidal hyperpigmentation. Eur J Ophthalmol 2021; 32:NP41-NP46. [PMID: 34015946 DOI: 10.1177/11206721211019573] [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: 11/17/2022]
Abstract
PURPOSE To report a series of cases showing bilateral circumpapillary hyperpigmentation on routine fundus examination. METHODS In this observational case series, three patients showing bilateral circumpapillary hyperpigmentation on routine fundus examination were included. Multimodal retinal imaging was done for these cases. RESULTS Multimodal imaging of the lesion showed the hyper pigmentation to be confined to the choroid. The optical coherence tomography scans described the features through the hyperpigmented area, adjacent hypopigmented area and the normally pigmented area of the fundus as suggestive of choroidal hyper melanosis. Follow-up of these lesions over a period of 2-6 years showed no change in the vision or characteristics of the lesion. CONCLUSION Bilateral circumpapillary hyperpigmentation needs to be considered as a differential for bilateral peripapillary pigmented lesions.
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Affiliation(s)
- Ramesh Venkatesh
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, Karnataka
| | - NikithaGurram Reddy
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, Karnataka
| | | | | | - Naresh Kumar Yadav
- Department of Retina and Vitreous, Narayana Nethralaya, Bengaluru, Karnataka
| | - Jay Chhablani
- Medical Retina and Vitreoretinal Surgery, University of Pittsburgh School of Medicine, Pittsburg, PA, USA
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Parikh R, Gal-Or O, Sakurada Y, Leong B, Freund KB. DOCUMENTATION OF A NEW CHOROIDAL NEVUS. Retin Cases Brief Rep 2021; 15:202-206. [PMID: 30289791 DOI: 10.1097/icb.0000000000000822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the occurrence of an acquired choroidal nevus in a 73-year-old white man. METHODS Case report. RESULTS A 73-year-old white man was referred for an evaluation and treatment of macular changes in his left eye consistent with pachychoroid neovasculopathy. Baseline funduscopic examination and color fundus photographs showed two small peripheral choroidal nevi in the right eye and a single small choroidal nevus in the far temporal macula of the left eye. Treatment with intravitreal aflibercept was initiated in the left eye on a treat-and-extend dosing regimen. Approximately 1 year later, a new pigmented choroidal lesion was detected in the left macula in an area where previous high-resolution color fundus photographs had shown no abnormal pigmentation. Swept-source optical coherence tomography of the new pigmented lesion showed flat hyperreflectivity within the inner choroid consistent with a small choroidal nevus. The patient was referred to his internist who found no evidence of an occult malignancy. Over the course of more than 4 additional years of continuous follow-up, the new choroidal nevus remained stable, no new fundus abnormalities were detected in either eye, and the patient remained medically stable. CONCLUSION To the best of our knowledge, this is the first documented case of a new choroidal nevus. Multimodal imaging performed before lesion detection and over the ensuing 4 years showed its stability, thus allowing for the conclusion that it was a benign choroidal nevus rather than a neoplastic or paraneoplastic process.
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Affiliation(s)
- Ravi Parikh
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York
- Vitreous Retina Macula Consultants of New York, New York, New York
| | - Orly Gal-Or
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York
- Vitreous Retina Macula Consultants of New York, New York, New York
- Department of Ophthalmology, Rabin Medical Center, Tel-Aviv, Israel
| | - Yoichi Sakurada
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York
- Vitreous Retina Macula Consultants of New York, New York, New York
- Departments of Ophthalmology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan ; and
| | - Belinda Leong
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York
- Vitreous Retina Macula Consultants of New York, New York, New York
| | - K Bailey Freund
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York
- Vitreous Retina Macula Consultants of New York, New York, New York
- Department of Ophthalmology, New York University School of Medicine, New York, New York
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Comment on Roelofs, K.A.; et al. Detecting Progression of Melanocytic Choroidal Tumors by Sequential Imaging: Is Ultrasonography Necessary? Cancers 2020, 12, 1856. Cancers (Basel) 2021; 13:cancers13061306. [PMID: 33804046 PMCID: PMC8000638 DOI: 10.3390/cancers13061306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 11/16/2022] Open
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Salehi O, van Wijngaarden P, Keel S, Foreman J, Dirani M, Damato B, O'Day R. Estimating malignancy risk of melanocytic choroidal tumours detected in the Australian National Eye Health Survey. Clin Exp Optom 2021; 104:854-858. [PMID: 33689655 DOI: 10.1080/08164622.2021.1878862] [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] [Indexed: 02/03/2023] Open
Abstract
Clinical relevance: The malignant potential of choroidal melanocytic tumours detected incidentally in the community is thought to be low, but this has not been assessed using a validated screening tool. An accurate characterisation of the malignant potential of these lesions has implications for resource allocation, service provision, education, and training.Background: MOLES (Mushroom shape, Orange Pigment, Large size, Enlargement, and Subretinal fluid) categorises tumours as 'common naevus', 'low-risk naevus', 'high-risk naevus', and 'probable melanoma'. The MOLES system recommends that patients with common naevi (score = 0) undergo review by a community optometrist every two years, ideally with sequential colour photography. For the remaining patients (score ≥ 1), specialist imaging and assessment are recommended, with referral triaged as non-urgent for patients with low-risk (score = 1) or high-risk naevi (score = 2) and urgent for patients with probable melanoma (score > 2).Methods: Lesions flagged as choroidal melanocytic tumours on retinal photographs taken during the Australian National Eye Health Survey were retrospectively analysed by an ocular oncologist. Each lesion was assigned a MOLES score and categorised as common, low-risk, high-risk or probable melanoma.Results: Seventy-seven choroidal naevi were identified. Seventy-five (97%) of the choroidal naevi were categorised as common naevi, with a MOLES score of 0. Two (3%) choroidal naevi had a score of 1 and diagnosed as low-risk naevi due to their size. No naevi had a score of 2 or more.Conclusion: All choroidal naevi detected in this nationally representative population survey were innocuous. This suggests that the vast majority of choroidal melanocytic tumours that are incidentally detected in Australia can be managed in primary eye care settings without the need for specialist referral. MOLES provides a simple evidence-based method for choroidal naevi assessment in primary care.
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Affiliation(s)
- Omar Salehi
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Peter van Wijngaarden
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Stuart Keel
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Joshua Foreman
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Mohamed Dirani
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Bertil Damato
- Nuffield Department of Clinical Neurosciences, Oxford University Hospital, Oxford, UK
| | - Roderick O'Day
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
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Li X, Wang L, Zhang L, Tang F, Wei X. Application of Multimodal and Molecular Imaging Techniques in the Detection of Choroidal Melanomas. Front Oncol 2021; 10:617868. [PMID: 33634026 PMCID: PMC7902045 DOI: 10.3389/fonc.2020.617868] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/16/2020] [Indexed: 02/05/2023] Open
Abstract
Choroidal melanomas are the most common ocular malignant tumors worldwide. The onset of such tumors is insidious, such that affected patients often have no pain or obvious discomfort during early stages. Notably, enucleation is required for patients with a severe choroidal melanoma, which can seriously impact their quality of life. Moreover, choroidal melanomas metastasize early, often to the liver; this eventually causes affected patients to die of liver failure. Therefore, early diagnosis of choroidal melanomas is extremely important. Unfortunately, an early choroidal melanoma is easily confused with a choroidal nevus, which is the most common benign tumor of the eye and does not often require surgical treatment. This review discusses recent advances in the use of multimodal and molecular imaging to identify choroidal melanomas and choroidal nevi, detect early metastasis, and diagnose patients with choroidal melanomas.
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Affiliation(s)
- Xuying Li
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Lixiang Wang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Li Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Fei Tang
- Department of Ophthalmology, ShangjinNanfu Hospital, Chengdu, China
| | - Xin Wei
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Department of Ophthalmology, ShangjinNanfu Hospital, Chengdu, China
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36
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Laíns I, Wang JC, Cui Y, Katz R, Vingopoulos F, Staurenghi G, Vavvas DG, Miller JW, Miller JB. Retinal applications of swept source optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Prog Retin Eye Res 2021; 84:100951. [PMID: 33516833 DOI: 10.1016/j.preteyeres.2021.100951] [Citation(s) in RCA: 116] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 02/08/2023]
Abstract
The advent of optical coherence tomography (OCT) revolutionized both clinical assessment and research of vitreoretinal conditions. Since then, extraordinary advances have been made in this imaging technology, including the relatively recent development of swept-source OCT (SS-OCT). SS-OCT enables a fast scan rate and utilizes a tunable swept laser, thus enabling the incorporation of longer wavelengths than conventional spectral-domain devices. These features enable imaging of larger areas with reduced motion artifact, and a better visualization of the choroidal vasculature, respectively. Building on the principles of OCT, swept-source OCT has also been applied to OCT angiography (SS-OCTA), thus enabling a non-invasive in depth-resolved imaging of the retinal and choroidal microvasculature. Despite their advantages, the widespread use of SS-OCT and SS-OCTA remains relatively limited. In this review, we summarize the technical details, advantages and limitations of SS-OCT and SS-OCTA, with a particular emphasis on their relevance for the study of retinal conditions. Additionally, we comprehensively review relevant studies performed to date to the study of retinal health and disease, and highlight current gaps in knowledge and opportunities to take advantage of swept source technology to improve our current understanding of many medical and surgical chorioretinal conditions. We anticipate that SS-OCT and SS-OCTA will continue to evolve rapidly, contributing to a paradigm shift to more widespread adoption of new imaging technology to clinical practice.
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Affiliation(s)
- Inês Laíns
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Jay C Wang
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Ying Cui
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA; Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Raviv Katz
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Filippos Vingopoulos
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA
| | - Giovanni Staurenghi
- Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", University of Milan, Italy
| | - Demetrios G Vavvas
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Joan W Miller
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - John B Miller
- Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Harvard Retinal Imaging Lab, Boston, MA, USA.
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Ortega MA, Fraile-Martínez O, García-Honduvilla N, Coca S, Álvarez-Mon M, Buján J, Teus MA. Update on uveal melanoma: Translational research from biology to clinical practice (Review). Int J Oncol 2020; 57:1262-1279. [PMID: 33173970 PMCID: PMC7646582 DOI: 10.3892/ijo.2020.5140] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 09/24/2020] [Indexed: 02/06/2023] Open
Abstract
Uveal melanoma is the most common type of intraocular cancer with a low mean annual incidence of 5‑10 cases per million. Tumours are located in the choroid (90%), ciliary body (6%) or iris (4%) and of 85% are primary tumours. As in cutaneous melanoma, tumours arise in melanocytes; however, the characteristics of uveal melanoma differ, accounting for 3‑5% of melanocytic cancers. Among the numerous risk factors are age, sex, genetic and phenotypic predisposition, the work environment and dermatological conditions. Management is usually multidisciplinary, including several specialists such as ophthalmologists, oncologists and maxillofacial surgeons, who participate in the diagnosis, treatment and complex follow‑up of these patients, without excluding the management of the immense emotional burden. Clinically, uveal melanoma generates symptoms that depend as much on the affected ocular globe site as on the tumour size. The anatomopathological study of uveal melanoma has recently benefited from developments in molecular biology. In effect, disease classification or staging according to molecular profile is proving useful for the assessment of this type of tumour. Further, the improved knowledge of tumour biology is giving rise to a more targeted approach to diagnosis, prognosis and treatment development; for example, epigenetics driven by microRNAs as a target for disease control. In the present study, the main epidemiological, clinical, physiopathological and molecular features of this disease are reviewed, and the associations among all these factors are discussed.
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Affiliation(s)
- Miguel A. Ortega
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28871 Madrid
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid
- University Center for The Defense of Madrid (CUD-ACD), 28047 Madrid
| | - Oscar Fraile-Martínez
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28871 Madrid
| | - Natalio García-Honduvilla
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28871 Madrid
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid
- University Center for The Defense of Madrid (CUD-ACD), 28047 Madrid
| | - Santiago Coca
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28871 Madrid
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid
- University Center for The Defense of Madrid (CUD-ACD), 28047 Madrid
| | - Melchor Álvarez-Mon
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28871 Madrid
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid
- University Center for The Defense of Madrid (CUD-ACD), 28047 Madrid
- Internal and Oncology Service (CIBER-EHD), University Hospital Príncipe de Asturias, Alcalá de Henares, 28805 Madrid
| | - Julia Buján
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28871 Madrid
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), 28034 Madrid
- University Center for The Defense of Madrid (CUD-ACD), 28047 Madrid
| | - Miguel A. Teus
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28871 Madrid
- Ophthalmology Service, University Hospital Príncipe de Asturias, Alcalá de Henares, 28805 Madrid, Spain
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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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CHOROIDAL NEVUS TRANSFORMATION INTO MELANOMA PER MILLIMETER INCREMENT IN THICKNESS USING MULTIMODAL IMAGING IN 2355 CASES: The 2019 Wendell L. Hughes Lecture. Retina 2020; 39:1852-1860. [PMID: 30883534 DOI: 10.1097/iae.0000000000002508] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To analyze risk of nevus transformation into melanoma per millimeter increment. METHODS Retrospective analysis of 3,806 choroidal nevi for transformation into melanoma per incremental millimeter thickness (flat [≤1.0 mm], thin [1.1-2.0 mm], thicker [2.1-3.0 mm], and thickest [>3.0 mm]) RESULTS:: The median nevus thickness was 1.4 mm, and nevi were categorized (flat, thin, thicker, and thickest) in 1,140 (30%), 2052 (54%), 555 (15%), and 59 (<1%), respectively. There were differences in tumor diameter (2.5, 4.8, 7.5, and 9.3 mm; P < 0.01), optical coherence tomography detection of overlying subretinal fluid (<1, 4, 15, and 11%; P < 0.01), overlying retinal edema (<1, 3, 14, and 25%; P < 0.01), overlying drusen (23, 49, 64, and 64%; P < 0.01), overlying retinal pigment epithelial detachment (1, 4, 4, and 9%; P < 0.01), and overlying lipofuscin hyperautofluoresence (<1, 3, 6, and 7%; P < 0.01). Choroidal nevus transformation into melanoma (n = 90/2,355 cases, 3.8%) was found by Kaplan-Meier 7-year estimates (2.2, 6.1, 31.7, and 34.5%; P < 0.0001) and by hazard ratio (HR) compared with nevus ≤1.0 mm (not available, 4.7 [P = 0.01], 35.7 [P < 0.0001], and 52.0 [P < 0.0001]). For all thicknesses, those with growth displayed increase in mean basal diameter of 2.4 mm and thickness of 1.1 mm, optical coherence tomography increase in subretinal fluid (65%), autofluorescence increase in lipofuscin (40%), and ultrasonography increase in hollowness (30%). Multivariable risk factors, recalled by the mnemonic "To Find Small Ocular Melanoma Doing IMaging" (TFSOM-DIM) representing Thickness >2 mm (ultrasonography), Fluid subretinal (optical coherence tomography), Symptom vision loss (Va), Orange pigment (autofluorescence), Melanoma hollow (ultrasonography), and DIaMeter >5 mm, revealed factors per incremental thickness category (compared with flat) including thin (Fluid overlying, HR 6.1; DIaMeter >5 mm, HR 3.3), thicker (Fluid subretinal ≤3 mm from nevus, HR 5.7; Melanoma acoustic hollowness, HR 2.7), and thickest (Orange pigment, HR 9.1). CONCLUSION Each incremental increase in choroidal nevus thickness demonstrated risk of growth into melanoma with HR (compared with flat) 4.7 for thin, 35.7 for thicker, and 52.0 for thickest. The increase from ≤2.0 mm to >2.0 mm thickness conferred the greatest rise for transformation.
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Kilgore DA, Sanders R, Uwaydat S. Novel and Unusual Retinal Findings in Two Patients with Neurofibromatosis Type 1. Case Rep Ophthalmol 2020; 11:588-594. [PMID: 33437232 PMCID: PMC7747081 DOI: 10.1159/000510013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/08/2020] [Indexed: 12/03/2022] Open
Abstract
Neurofibromatosis type 1 (NF1) is a phacomatosis known to be associated with several developmental abnormalities in multiple organ systems including the eyes. NF1 can present with varying ophthalmic manifestations, including Lisch nodules, retinal astrocytic hamartomas, capillary hemangiomas, plexiform neurofibromas, and choroidal nodules. We present 2 cases of NF1 with presentations that may represent underreported retinal abnormalities occurring in NF1. Case 1 presents a patient who developed spontaneous peripheral retinal dialysis with subsequent retinal detachment; case 2 discusses a patient with multiple pigmented choroidal lesions bilaterally.
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Affiliation(s)
| | | | - Sami Uwaydat
- *Sami Uwaydat, MD, Jones Eye Institute, Department of Ophthalmology, University of Arkansas for Medical Sciences, 4301 West Markham St., Slot 523, Little Rock, AR 72205 (USA),
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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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Al Harby L, Ali Z, Rajai A, Roberts SA, Peto T, Leung I, Gray J, Hay G, Arora AK, Keane PA, Cohen VML, Sagoo M, Balaskas K. Prospective validation of a virtual clinic pathway in the management of choroidal naevi: the NAEVUS study Report no. 1: safety assessment. Br J Ophthalmol 2020; 106:128-134. [PMID: 33037007 DOI: 10.1136/bjophthalmol-2020-317371] [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: 06/29/2020] [Revised: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Choroidal naevi are a common incidental finding prompting specialist referrals to ocular oncology. Rarely, such lesions have sufficient suspicious features to diagnose a small melanoma. The aim of the study is to show that 'virtual' imaging-based pathways are a safe and efficient option to manage such referrals. METHODS A prospective cohort study at the Manchester Royal Eye Hospital and Moorfields Eye Hospital between June 2016 and July 2017 of the management decision of 400 patients reviewed by an ophthalmologist in a face-to-face consultation (gold standard) supported by fundus photography, optical coherence tomography, autofluorescence (AF) and B-mode ultrasound. The images were also read independently by blinded graders (non-medical) and blinded ophthalmologists, and a management decision was made based on image review alone (virtual pathway). The two pathways were compared for safety. RESULTS The agreement for management decisions between face-to-face and virtual pathways was 83.1% (non-medical) and 82.6% (medical). There were more over-referrals in the virtual pathway (non-medical 24.3%, medical 23.3% of gold standard discharge) and only two under-referrals (10.5% of gold standard referrals), both borderline cases with minimal clinical risk. The agreement for risk factors of growth (orange pigment, subretinal fluid, hyper-AF) ranged between 82.3% and 97.3%. CONCLUSIONS We prospectively validated a virtual clinic model for the safe management of choroidal naevi. Such a model of care is feasible with low rate of under-referral. An over-referral rate of almost 24% from the vitrual pathway needs to be factored into designing such pathways in conjunction with evidence on their cost-effectiveness.
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Affiliation(s)
- Lamis Al Harby
- Ocular Oncology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Zaria Ali
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Azita Rajai
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester, UK
| | - Stephen A Roberts
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester, UK
| | - Tunde Peto
- Centre for Public Health, Blackwell's Queen's University Belfast, Belfast, UK
| | - Irene Leung
- Moorfields Ophthalmic Reading Centre, NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - Jane Gray
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Gordon Hay
- Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Amit K Arora
- Ocular Oncology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Pearse A Keane
- Moorfields Ophthalmic Reading Centre, NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK.,Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Mandeep Sagoo
- Moorfields Ophthalmic Reading Centre, NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK.,Barts Health NHS Trust, London, UK
| | - Konstantinos Balaskas
- Moorfields Ophthalmic Reading Centre, NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK .,Medical Retina, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Remote screening of retinal and optic disc diseases using handheld nonmydriatic cameras in programmed routine occupational health checkups onsite at work centers. Graefes Arch Clin Exp Ophthalmol 2020; 259:575-583. [PMID: 32728935 PMCID: PMC7391026 DOI: 10.1007/s00417-020-04860-z] [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: 04/22/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose To evaluate the first year outcomes of a remote screening program for detection of retinal diseases using handheld nonmydriatic cameras in occupational routine checkups performed onsite at work centers. Methods Cross-sectional, first year screening program outcomes audit. Participants were volunteers recruited from staff within work centers. Retinal fundus images were captured by technicians, and images and data were anonymized and sent securely to a remote server. A team of ophthalmologists, all retinal specialists, remotely read the images using a custom-made software and sent telematic reports of findings within 24–48 h. The main items evaluated were the detection of retinal abnormalities and the relationship between retinal findings and demographic data such as age and sex. Results A total of 19,881 workers were evaluated in 52 centers. Mean age was 41.1 years old, 43.9% men and 56.1% women. Mean duration of the test was around 2 min. Of the workers, 7.8% presented abnormalities in retinal fundus images, being the main findings choroidal nevus (2.4%), macular pigment abnormalities (1.5%), glaucomatous optic disc (1.2%), and macular signs of high myopia (1.1%). The presence of abnormalities was associated with greater age, being 5%, 7.9%, 12.6%, and 19.7% in workers less than 40 years, from 40 to 49, 50–59, and ≥ 60 years (p < 0.05), respectively. Men had more abnormalities in retinal fundus images than women (8.6 vs. 7.2; p < 0.05 RR: 1.2; CI 1092–1322). Conclusions Mass screening of retinal and optic disc abnormalities during occupational health routine checkups is a feasible, quick, and efficient tool for early detection of potential vision-threatening disease markers.
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Yamamoto M, Miura Y, Kyo A, Hirayama K, Kohno T, Theisen-Kunde D, Brinkmann R, Honda S. Selective retina therapy for subretinal fluid associated with choroidal nevus. Am J Ophthalmol Case Rep 2020; 19:100794. [PMID: 32637732 PMCID: PMC7327275 DOI: 10.1016/j.ajoc.2020.100794] [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: 02/07/2020] [Revised: 06/01/2020] [Accepted: 06/12/2020] [Indexed: 01/14/2023] Open
Abstract
Purpose To report a case of a patient with subretinal fluid (SRF) associated with choroidal nevus (CN), who was treated with selective retina therapy (SRT) and ultimately achieved resolution of the SRF. Observations A 41-year-old man with SRF associated with CN in his right eye (RE) underwent ophthalmologic evaluation, including optic coherence tomography, fluorescein angiography (FA) and indocyanine green angiography. The best corrected visual acuity (BCVA) converted to the logarithm of the minimum angle of resolution (logMAR) was 0.00 in the RE. SRT (532 nm, 1.7 μs pulse duration, 30 pulses in 100Hz; Medical Laser Center Lübeck) was performed with the laser spots equally distributed across the FA leakage area. Until 20 months SRT was repeated several times because the SRF decreased every time in response to SRT, but was not completely resolved and sometimes increased with time. After performing 6 times of SRT session, leakage on FA stopped at 21 months follow-up and SRF was resolved at 31 months. At 60 months after the first SRT, there were no signs of malignant transformation, no SRF, and the BCVA in the RE was 0.22. Conclusions and Importance SRT seems to be a useful treatment and proper clinical studies are necessary to establish the best treatment protocol for SRF associated with CN.
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Affiliation(s)
- Manabu Yamamoto
- Department of Ophthalmology and Visual Science, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yoko Miura
- Medical Laser Center Lübeck, Lübeck, Germany.,Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany.,Department of Ophthalmology University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Akika Kyo
- Department of Ophthalmology and Visual Science, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kumiko Hirayama
- Department of Ophthalmology and Visual Science, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takeya Kohno
- Department of Ophthalmology and Visual Science, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | - Ralf Brinkmann
- Medical Laser Center Lübeck, Lübeck, Germany.,Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany
| | - Shigeru Honda
- Department of Ophthalmology and Visual Science, Osaka City University Graduate School of Medicine, Osaka, Japan
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Ultra-wide-field imaging assessment of small choroidal pigmented lesions using red and green colour channels. Eye (Lond) 2020; 35:282-288. [PMID: 32367003 DOI: 10.1038/s41433-020-0900-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 01/10/2020] [Accepted: 04/15/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Diagnosis of small choroidal melanoma is mainly based on tumour thickness, subretinal fluid, or lipofuscin pigment. Ultra-wide-field imaging (UWF) allows depiction of choroidal lesions through a red (RC) and a green channel (GC). Aim of the study was to determine the utility of this tool in the detection of small choroidal melanoma. METHODS Retrospective cross-sectional study of patients with small choroidal pigmented lesions up to 3 mm in thickness. All patients underwent clinical and imaging assessment including UWF. Lesions were subcategorized based on thickness and lesion type. A qualitative assessment ensued using the red and green channels feature. RESULTS A total of 152 patients were included. Melanotic naevi (76/152,50%) and small choroidal melanomas (55/152,36%) were the predominant types. Thickness was <1 mm in 30% (46/152), 1-2 mm in 46% (70/152) and 2-3 mm in 24% (36/152) of cases. Two distinct imaging patterns were noted: dark on RC/undetectable on GC and dark on RC/light on GC. In melanotic naevi the dark on RC/light on GC pattern was significantly associated with increased tumour thickness (p = 0.006) and the presence of lipofuscin (p < 0.001) suggesting a potential prognostic significance. In small melanomas such an association was not established. The majority of small melanomas manifested a dark on RC/undetectable on GC pattern despite the presence of subretinal fluid and lipofuscin. CONCLUSIONS UWF imaging of choroidal pigmented tumours with red-green channels revealed two distinct patterns. The dark on RC/light on GC pattern was more common in suspicious melanotic naevi, but not in small melanomas. The use of red-green channels is not a reliable diagnostic tool in the early detection of small melanomas.
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Real-world outcomes of allied health professional-led clinic model for assessing and monitoring ocular melanocytic lesions. Eye (Lond) 2020; 35:464-469. [PMID: 32317788 PMCID: PMC8026979 DOI: 10.1038/s41433-020-0873-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 03/29/2020] [Accepted: 03/30/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Naevomelanocytic lesions comprise an increasing workload in ophthalmic secondary care and, although largely benign, carry high risk of mortality in case of malignant transformation. Previous studies highlight the theoretical strength of virtual models in monitoring such lesions and the role of allied health professionals (AHPs). We aim to describe and validate a "real-world" functional clinical model utilising these particular resources. METHODS New and existing follow-up patients from November 2016 to June 2019 with melanocytic lesions of the uveal tract and conjunctiva were directed into an optometrist-led, consultant-supported, clinic. Diagnostic tests included colour photography, autofluorescence, enhanced-depth imaging and ultrasound biomicroscopy. New patients were examined face-to-face initially, then virtually on subsequent visits. Suspicious lesions were referred to the consultant, with tertiary oncology referrals made as necessary. Clinical concordance between optometrist and consultant, patient satisfaction and outcomes of second opinion requests were audited. RESULTS Eight hundred and twenty-five patient episodes were encountered: 419 new and 406 follow-up. Between July 1st and August 31st 2018, 72 cases were audited. There was 98.6% concordance between AHP and consultant for diagnosis and management. Referral for consultant second opinion was requested in 18(2%) clinical encounters, with 4(0.5%) referred on to the oncology centre, of which 3 received treatment. Of 65 patients responding to a patient satisfaction survey, 100% were satisfied with their experience and 95% were happy to continue monitoring by the AHP. CONCLUSION With robust training and assessment, AHP-led service models are a highly efficient in busy units, without compromising patient safety.
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Abstract
PURPOSE To investigate the macular changes over time in eyes containing subretinal drusenoid deposits (also known as pseudodrusen) with no drusen >63 µm. METHODS A consecutive series of patients were examined with color fundus photography, optical coherence tomography, and autofluorescence imaging with fluorescein angiography used as necessary. Exclusionary criteria included macular neovascularization, history of retinal surgery, pseudoxanthoma elasticum, and drusen >63 µm. RESULTS There were 85 eyes of 54 patients. The mean age at baseline was 83.6 (±7.8) years, and there were 17 men. The mean follow-up was 5.0 (±2.9) years. At initial optical coherence tomography examination, 12 eyes had extrafoveal atrophy and 17 eyes had vitelliform deposits, which were yellowish white subretinal collections that showed intense hyperautofluorescence. During follow-up, 11 eyes lost vitelliform material. After the disappearance of small deposits, focal hyperpigmentation remained. Loss of larger deposits was associated with noteworthy sequela; six developed subfoveal atrophy and one macular neovascularization close to regressing vitelliform material. Subfoveal geographic atrophy developed in four other eyes without vitelliform material by extension from areas of extrafoveal atrophy. Macular neovascularization developed in seven eyes over follow-up. The CFH Y402H and ARMS2 A69S allele frequencies were 57% and 48.9%, respectively, which is similar to a group of age-related macular degeneration controls. One patient had a novel PRPH2 mutation, but did not have a vitelliform deposit; the remainder had a normal PRPH2 and BEST1 coding sequences. CONCLUSION Eyes with subretinal drusenoid deposits and no drusen >63 mm have significant risk for the development of both neovascularization and geographic atrophy, the fundamental components of late age-related macular degeneration. An intermediate step in some eyes was the development of a vitelliform deposit, an entity not traditionally associated with age-related macular degeneration, but in these patients, the material seemed to be an important component of the disease pathophysiology. This vitelliform deposit was not associated with genetic markers for pattern dystrophy or Best disease.
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Mastropasqua L, Perilli R, D'Aloisio R, Toto L, Mastropasqua A, Donato S, Taraborrelli M, Ginestra F, Porta M, Consoli A. Why Miss the Chance? Incidental Findings while Telescreening for Diabetic Retinopathy. Ophthalmic Epidemiol 2020; 27:237-245. [PMID: 31958252 DOI: 10.1080/09286586.2020.1715450] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE To report on incidental pathological findings met while screening for Diabetic Retinopathy (DR) in Diabetes Clinics (DC) by ophthalmologist-graded digital fundus imaging. METHODS At the DC of Pescara (central Italy), for 3,859 eyes of 1,930 consecutive patients having not undergone fundus examination in the last year, two mydriatic fundus digital images, taken with a CenterVue DRS Digital Retinal Camera, were sent along with Best Corrected Visual Acuity, on a "store-and-forward" basis, to an ophthalmologist trained in DR screening, and graded according to the UK Diabetic Eye Screening Programme. Incidental fundus abnormalities other than DR were reported. RESULTS No adverse event to mydriasis was reported. One hundred and eighty eyes (4.66%) were ungradable. Among the 3,679 gradable ones, 1,105 (30.04%) showed different degrees of DR (R1 to R3), and 126 (3.42%) maculopathy (M1). Any Age-Related Macular Degeneration was present in 387 eyes (10.52%), any optic disc and parapapillary area features suspect for glaucoma in 562 eyes (15.27%), any hypertensive retinopathy in 1,263 eyes (34.33%), vitreoretinal interface disease in 252 eyes (6.84%), myopic choroidopathy in 92 eyes (2.50%), disc pallor in 31 eyes (0.84%). Mean time was 5 min for screening, 2 min for grading. CONCLUSION Teleretinography is a well-established, cost-effective procedure in DR screening. Along with increased attendance, locating a digital camera in a DC with a retina-specialist grader results in finding fundus pathologies also beyond DR, very similarly to fundus examination in an outpatient ophthalmic setting.
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Affiliation(s)
- Leonardo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. d'Annunzio Chieti-Pescara , Chieti, Italy
| | - Roberto Perilli
- Territorial Ophthalmology Unit, Local Health Authority , Pescara, Italy
| | - Rossella D'Aloisio
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. d'Annunzio Chieti-Pescara , Chieti, Italy
| | - Lisa Toto
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. d'Annunzio Chieti-Pescara , Chieti, Italy
| | - Alessandra Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. d'Annunzio Chieti-Pescara , Chieti, Italy
| | - Simone Donato
- Chair of Endocrinology and Metabolic Diseases, University G. d'Annunzio Chieti-Pescara , Chieti, Italy
| | - Merilda Taraborrelli
- Chair of Endocrinology and Metabolic Diseases, University G. d'Annunzio Chieti-Pescara , Chieti, Italy
| | - Federica Ginestra
- Chair of Endocrinology and Metabolic Diseases, University G. d'Annunzio Chieti-Pescara , Chieti, Italy
| | - Massimo Porta
- Chair of Internal Medicine, Department Of Medical Sciences, University of Turin , Turin, Italy
| | - Agostino Consoli
- Chair of Endocrinology and Metabolic Diseases, University G. d'Annunzio Chieti-Pescara , Chieti, Italy
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Stark MS, Gray ES, Isaacs T, Chen FK, Millward M, McEvoy A, Zaenker P, Ziman M, Soyer HP, Glasson WJ, Warrier SK, Stark AL, Rolfe OJ, Palmer JM, Hayward NK. A Panel of Circulating MicroRNAs Detects Uveal Melanoma With High Precision. Transl Vis Sci Technol 2019; 8:12. [PMID: 31737436 PMCID: PMC6855372 DOI: 10.1167/tvst.8.6.12] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 08/29/2019] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To determine if a circulating microRNA (miRNA) panel could be used to distinguish between uveal melanoma and uveal nevi. METHODS We report on a multicenter, cross-sectional study conducted between June 2012 and September 2015. The follow-up time was approximately 3 to 5 years. Blood was drawn from participants presenting with a uveal nevus (n = 10), localized uveal melanoma (n = 50), or metastatic uveal melanoma (n = 5). Levels of 17 miRNAs were measured in blood samples of study participants using a sensitive real-time PCR system. RESULTS A panel of six miRNAs (miR-16, miR-145, miR-146a, miR-204, miR-211, and miR-363-3p) showed significant differences between participants with uveal nevi compared with patients with localized and metastatic uveal melanoma. Importantly, miR-211 was able to accurately distinguish metastatic disease from localized uveal melanoma (P < 0.0001; area under the curve = 0.96). When the six-miRNA panel was evaluated as a group it had the ability to identify uveal melanoma when four or more miRNAs (93% sensitivity and 100% specificity) reached or exceeded their cut-point. CONCLUSIONS This miRNA panel, in tandem with clinical findings, may be suited to confirm benign lesions. In addition, due to the panel's high precision in identifying malignancy, it has the potential to augment melanoma detection in subsequent clinical follow-up of lesions with atypical clinical features. TRANSLATIONAL RELEVANCE Uveal nevi mimic the appearance of uveal melanoma and their transformation potential cannot be definitively determined without a biopsy. This panel is most relevant at the nevus stage and in lesions with uncertain malignant potential as a companion diagnostic tool to assist in clinical decision-making.
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Affiliation(s)
- Mitchell S. Stark
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
| | - Elin S. Gray
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Crawley, Western Australia, Australia
| | - Timothy Isaacs
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia
- Perth Retina, West Leederville, Western Australia, Australia
| | - Fred K. Chen
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia
- Lions Eye Institute, Nedlands, Western Australia, Australia
| | - Michael Millward
- School of Medicine and Pharmacology, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Ashleigh McEvoy
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Pauline Zaenker
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Melanie Ziman
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Biomedical Science, The University of Western Australia, Crawley, Western Australia, Australia
| | - H. Peter Soyer
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - William J. Glasson
- Queensland Ocular Oncology Service, The Terrace Eye Centre, Brisbane, Queensland, Australia
| | - Sunil K. Warrier
- Queensland Ocular Oncology Service, The Terrace Eye Centre, Brisbane, Queensland, Australia
| | - Andrew L. Stark
- Queensland Ocular Oncology Service, The Terrace Eye Centre, Brisbane, Queensland, Australia
| | - Olivia J. Rolfe
- Queensland Ocular Oncology Service, The Terrace Eye Centre, Brisbane, Queensland, Australia
| | - Jane M. Palmer
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
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Bontzos G, Moysaki N, Tsatsos M, Kozobolis V, Detorakis ET. Preliminary results of a semi-automated platform for pixel-based quantification of choroidal naevus progression. Can J Ophthalmol 2019; 54:601-605. [PMID: 31564351 DOI: 10.1016/j.jcjo.2018.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 12/17/2018] [Accepted: 12/20/2018] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate a novel method for choroidal naevus progression monitoring using semiautomated software for pixel-based quantification. METHODS Retrospective analysis of patients with choroidal melanotic lesions. In total, 87 eyes fulfilled our inclusion criteria. The progression of the choroidal lesions was evaluated by 2 masked and independent investigators. Total naevus area was measured on fundoscopic images using ImageJ semiautomated segmentation at baseline examination and 5 years later. The efficacy of our method was also tested on a separate patient group applying test-retest analysis. RESULTS Pixel-based analysis for objective quantification, displayed high repeatability, and reliability. We identified 4 cases of naevus size progression using the described semiautomated technique, while only 2 cases of progression were reported by simple observation. The novel method performance displayed 50% increased sensitivity over simple observation and 100% specificity. CONCLUSIONS The presented method of displayed higher sensitivity and specificity compared to conventional observation and photograph qualification. Our results imply that the proposed methodology may be applicable as an accurate, easily employed diagnostic tool for the early detection of size progression in melanotic choroidal lesions.
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Affiliation(s)
- Georgios Bontzos
- Eye Clinic of the University General Hospital of Heraklion, Crete, Greece.
| | - Nektaria Moysaki
- Eye Clinic of the University General Hospital of Heraklion, Crete, Greece; Eye Clinic of the University Hospital of Alexandroupolis, Dragana, Greece
| | - Michael Tsatsos
- Royal Eye Infirmary, Dorset County Hospital NHS Foundation Trust, Dorchester, U.K; Southampton University Hospitals NHS Foundation Trust, Southampton, U.K
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