Widefield imaging of retinal and choroidal tumors

Background

Wide-field imaging plays an increasingly important role in ocular oncology clinics. The purpose of this review is to describe the commonly used wide-field imaging devices and review conditions seen in ocular oncology clinic that underwent wide-field imaging as part of the multimodal evaluation.

Summary of review

Wide-field or wide-angle imaging is defined as greater than 50° field of view. Modern devices can reach far beyond this reporting fields of view up to 267°, when utilizing montage features, with increasingly impressive resolution. Wide-field imaging modalities include fundus photography, fluorescein angiography (FA), fundus autofluorescence (FAF), indocyanine angiography (ICG), spectral domain optical coherence tomography (SD-OCT), and recently wide-field OCT Angiography (OCTA). These imaging modalities are increasingly prevalent in practice. The wide-field systems include laser, optical, and lens based systems that are contact or non-contact lens systems each with its own benefits and drawbacks. The purpose of this review is to discuss commonly used wide-field imaging modalities for retinal and choroidal tumors and demonstrate the use of various widefield imaging modalities in select ocular oncology cases.

Conclusions

Clinical examination remains the gold standard for the evaluation of choroidal and retinal tumors. Wide-field imaging plays an important role in ocular oncology for initial documentation, surgical planning, determining the relationship of the tumor to adjacent ocular structures, following tumor size after treatment, and monitoring for recurrence.

Further observations on a bilateral IRVAN syndrome case

PURPOSE

Reporting clinical features of the late course of the disease after long-term follow-up in a bilaterally affected patient with idiopathic retinitis, vasculitis, retinal aneurysms and neuroretinitis (IRVAN) and new peripheral retinal findings on wide-field angiography and multimodal imaging.

METHODS

This was a retrospective observational study, based on current diagnostic studies including wide-field fluorescein angiography, optical coherence tomography (OCT) and treatment of aneurysms with argon laser photocoagulation.

RESULTS

A 21-year-old female with bilateral IRVAN syndrome-stage 2 in the right eye and stage 3 in the left eye-previously treated bilaterally with laser photocoagulation for retinal macroaneurysms and ischemic areas between 1985 and 1992. Follow-up interrupted on two occasions, with subsequent fundus re-examinations confirming the prevention of retinal neovascularization in both eyes, as recently evidenced on wide-field angiography.

CONCLUSIONS

A case of bilateral IRVAN disease with multiple retinal aneurysms, neuroretinitis and peripheral capillary nonperfusion successfully treated with laser photocoagulation, maintaining normal visual acuity in one eye and preventing retinal neovascular complications.

Wide-field fluorescein angiography findings in active anterior scleritis

OBJECTIVE

Describe the proportion of patients with wide-field fluorescein angiographic (WFFA) findings in patients with active anterior scleritis.

METHODS

An observational, descriptive, cross-sectional study of the WFFA findings of patients with active anterior scleritis including nodular, diffuse, or necrotizing involvement was performed. Studies were performed with the Heidelberg Spectralis module (102º). Images were saved and assessed by two masked co-authors.

RESULTS

Seventy-nine eyes from 39 patients, 31 (79%) females with a mean age of 50.5 years ± 13.98. Mean best-corrected visual acuity (BCVA) of 0.1343 ± 0.2475 logMar or 20/27. WFFA findings were observed in 39.58% of eyes with active scleritis and in 16.66% of eyes without scleritis. Systemic association was present at 50%, with ANCA-associated vasculitis being the most prevalent. WFFA findings were more frequent in cases of anterior diffuse scleritis and correlated with scleritis severity when central and peripheral leakage (p < 0.022) and cystoid macular edema (p < 0.013) were present.

CONCLUSIONS

Almost 40% of eyes with anterior scleritis have WFFA findings of vascular leakage and 16% of eyes without scleritis. Retinal vascular leakage needs to be explored as a sign of local and/or systemic activity in patients with anterior scleritis and may have implications for disease severity and management.