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Choroidal melanoma. (a) Small choroidal melanoma with overlying RPE hyperplasia and diffuse orange pigment accumulation. (b) Spectral domain OCT clearly demonstrates subretinal fluid that could have been missed by clinical examination alone. Overlying the dome-shaped elevation of the choroid is a thickened irregular RPE and thickening of the outer retinal layers.
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fig2: Choroidal melanoma. (a) Small choroidal melanoma with overlying RPE hyperplasia and diffuse orange pigment accumulation. (b) Spectral domain OCT clearly demonstrates subretinal fluid that could have been missed by clinical examination alone. Overlying the dome-shaped elevation of the choroid is a thickened irregular RPE and thickening of the outer retinal layers.

Mentions: Subretinal fluid is an important characteristic related to underlying choroidal melanoma. Muscat and coworkers studied 20 untreated choroidal melanoma and detected subretinal fluid using time domain OCT in all cases [18]. Espinoza and colleagues also used time domain OCT to describe an active OCT pattern, wherein a localized serous retinal detachment was associated with an overlying retina of normal thickness, a feature that was highly associated with documented tumor growth (P = 0.033) and future treatment (P = 0.014) [19]. In contrast, a chronic OCT pattern, wherein the overlying retina was thinned, contains intraretinal cysts and with RPE thickening was associated with a long-standing lesion more likely to remain dormant [19]. Sayanagi and coworkers used 3D spectral domain OCT and found a significantly higher prevalence of subretinal fluid (91% versus 14%), retinal edema (61% versus 14%), and subretinal deposits (61% versus 11%) in choroidal melanoma compared with nevi [10]. Singh and associates used spectral domain OCT to describe dispersed accumulation of subretinal deposits corresponding to orange pigment over a small choroidal melanoma that had not been found with time domain OCT [20]. Spectral domain OCT was also capable of detecting early vitreous seeding as highly reflective 20–30 micron spheroidal bodies in the vitreous [21]. The limitation of OCT for choroidal melanoma lies in the difficulty of imaging the overlying retina for large melanomas and the inability to image past the anterior choroidal surface [19]. Reflectivity of the anterior choroid in melanoma is variable even with spectral domain OCT [20] (Figure 2).

Optical Coherence Tomography of Retinal and Choroidal Tumors

Say EA, Shah SU, Ferenczy S, Shields CL - J Ophthalmol (2011)

Bottom Line: In ocular oncology, OCT provides axial resolution to approximately 7 microns with cross-sectional images of the retina, delivering valuable information on the effects of intraocular tumors on the retinal architecture.Some effects include retinal edema, subretinal fluid, retinal atrophy, photoreceptor loss, outer retinal thinning, and retinal pigment epithelial detachment.Future improvements in image resolution and depth will allow better understanding of the mechanisms of visual loss, tumor growth, and tumor management.

Affiliation: Oncology Service, Wills Eye Institute, Thomas Jefferson University, Suite 1440, 840 Walnut Street, Philadelphia, PA 19107, USA.

ABSTRACT
Optical coherence tomography (OCT) has revolutionized the field of ophthalmology since its introduction 20 years ago. Originally intended primarily for retina specialists to image the macula, it has found its role in other subspecialties that include glaucoma, cornea, and ocular oncology. In ocular oncology, OCT provides axial resolution to approximately 7 microns with cross-sectional images of the retina, delivering valuable information on the effects of intraocular tumors on the retinal architecture. Some effects include retinal edema, subretinal fluid, retinal atrophy, photoreceptor loss, outer retinal thinning, and retinal pigment epithelial detachment. With more advanced technology, OCT now provides imaging deeper into the choroid using a technique called enhanced depth imaging. This allows characterization of the thickness and reflective quality of small (<3 mm thick) choroidal lesions including choroidal nevus and melanoma. Future improvements in image resolution and depth will allow better understanding of the mechanisms of visual loss, tumor growth, and tumor management.

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