Choroidal nevus in an eye with polypoidal choroidal vasculopathy

Prevalence of choroidal nevi in patients with central serous chorioretinopathy

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.

Choriocapillary vascular density changes in choroidal neovascularization associated with choroidal nevus after anti-VEGF injections

PURPOSE

To evaluate choriocapillary vascular density changes in choroidal neovascularization (CNV) type 2 associated with choroidal nevus using optical coherence tomography angiography (OCT-A) before and after anti-VEGF treatment.

METHODS

Observational case report.

RESULTS

A 25-year-old woman, was referred to Eye Clinic and presented a decreased visual acuity in right eye. Fundus examination showed a pigmented lesion located in macular region associated with subretinal hemorrhages adjacent to the mass in right eye. The diagnosis of choroidal nevus-associated with CNV was made and confirmed by spectral domain (SD)-OCT, OCT-A, and ultrasound examination. Two monthly ranibizumab intravitreal injections (IVT) were performed and a regression of the activity of neovascular lesion was noted. OCT-A showed a reduction of choriocapillaris vessel density (VD) before the treatment and an increase of VD after IVT injections.

CONCLUSION

OCT-A could be a non-invasive and diagnostic tool to evaluate choriocapillaris vascular changes after IVT injections in CNV associated with choroidal nevus.

Choroidal nevus and polypoidal vasculopathy: case series

BACKGROUND

To report an association between choroidal nevus and polypoidal choroidal vasculopathy (PCV) in three patients.

CASE PRESENTATION

We have encountered 3 isolated patients in our center presenting with subretinal exudation and a choroidal nevus that were thoroughly evaluated by slit lamp biomicroscopy, fundus photos, Fluorescein angiography (FA), indocyanine green angiography (ICG), B-scan ultrasound, and optical coherence tomography (SD-OCT-Heidelberg). The classic features of choroidal neovascularization seen on PVC were present in all 3 patients, all of whom had a substantial response to intravitreous antiangiogenic agent. OCT, Fluorescein and ICG Angiography, and Fundus autofluorescence (FAF) revealed similar findings in all cases.

DISCUSSION AND CONCLUSIONS

We have identified a clinical pattern of PCV and choroidal nevus that can be diagnosed early using fluorescein angiography, ICG and OCT.

Polypoidal lesions associated to choroidal naevus: spectrum of pachychoroid disease?

A 78-year-old woman was referred by an optician for an incidental finding of peripapillary naevus in the absence of visual symptoms. On examination, the right eye showed a choroidal naevus of around 1.5 disc diameter, adjacent to the optic disc. Optical coherence tomography detected the presence of pigment epithelium detachment and subretinal fluid within the context of the naevus. Fundus fluorescein angiography and indocyanine green showed multiple polypoidal lesions (Polypoidal Choroidal Vasculopathy, PCV) in the choroid within the spectrum of a pachychoroid, without any sign of malignancy related to neovascularisation. The patient underwent a follow-up of 6 months, showing stability of the lesions over this timeframe. No treatment has been required since the polypoidal lesions were outside the fovea and visual acuity remained stable. The association between choroidal naevi and polypoidal lesions is rare1; however, this seems to confirm that these findings are part of the spectrum of pachychoroid disease.

Optical Coherence Tomography Angiography of Polypoidal Neovascularization Associated with Choroidal Nevus

Purpose

To report a case of juxtapapillary polypoidal choroidal neovascularization (PCNV) associated with choroidal nevus investigated by means of optical coherence tomography angiography (OCT-A).

Methods

Case report.

Results

A 72-year-old woman presented with visual loss and metamorphopsia in her left eye for 5 days secondary to PCNV that developed on the border of a juxtapapillary choroidal nevus. Fluorescein angiography, indocyanine green angiography, and spectral-domain OCT confirmed the diagnosis. En face OCT-A disclosed a large tangled hyperreflective PCNV spreading from the optic disc at different levels of the choriocapillaris; the polyp lumina appeared hyporeflective. The patient was treated with 3 intravitreal injections of anti-vascular endothelial growth factor with partial functional recovery.

Conclusions

Our case showed the application of OCT-A in the diagnosis of a case of active PCNV complicating a benign intraocular tumor.

Ocular ultrasonography focused on the posterior eye segment: what radiologists should know

Abstract

Ocular B-mode ultrasonography (US) is an important adjuvant for the clinical assessment of a variety of ocular diseases. When ophthalmoscopy is not possible, mainly due to opacification of the transparent media (e.g., mature cataract or vitreous haemorrhage), US can guide the ophthalmologist in diagnosing disease and choosing treatment. The superficial location and cystic structure of the eye make US ideal for imaging of the eye. Moreover, dynamic study helps distinguish between various conditions that would otherwise be difficult to differentiate in some clinical setting, such as vitreous, retinal, and choroidal detachment. US is also good technique for detecting other pathologic conditions such as lens dislocation, vitreous haemorrhage, asteroid hyalosis, optic disc drusen, and tumors (e.g., choroidal melanoma, metastases, hemangioma). An understanding of the basic anatomy of the eye, the US technique, and common entities that affect the ocular globe will allow radiologists to offer this valuable imaging modality to patients and referring clinicians. This article focuses on the US anatomy and pathologic conditions that affect the posterior ocular segment.

Teaching points

• US is specially indicated when ocular fundus cannot be assessed on ophthalmoscopy.

• Multipurpose equipment with high-frequency transducers is optimal for imaging the eye.

• Ultrasound can reliably depict ocular anatomy and pathology as detachments and tumours.

• Dynamic examination is vital for distinguishing certain pathologic conditions as detachments.

Electronic supplementary material

The online version of this article (doi:10.1007/s13244-016-0471-z) contains supplementary material, which is available to authorized users.

Type 1 neovascularization with polypoidal lesions complicating dome shaped macula

Dome-shaped macula is described as an inward bulge of the macula within a posterior staphyloma in highly myopic eyes. Choroidal neovascularization is a known complication that can cause visual loss in dome-shaped macula. Herein, we describe a patient who presented with features of polypoidal choroidal neovascularization that developed on a background of high myopia with dome-shaped macula.