Autofluorescence characteristics of suspicious choroidal nevi.
ABSTRACT The aim of this study was to describe autofluorescence characteristics of 30 suspicious choroidal nevi.
Fundus autofluorescence (FAF) images were reviewed retrospectively on 30 consecutive cases of suspicious choroidal nevi. Autofluorescence imaging was achieved using a fundus camera-based system with a barrier filter of 695 nm and excitation of 580 nm. All nevi exhibited one or more of the following characteristics: tumor thickness, basal dimension greater than 5 mm, subretinal fluid, posterior location, ophthalmic symptoms, or lipofuscin (orange pigment).
Suspicious choroidal nevi were found to have specific FAF features. Orange pigment was noted in 67% of the nevi and appeared as very bright hyperfluorescent areas. Overlying retinal pigment epithelium hypertrophy and atrophy were noted in 50% and appeared darkly hypofluorescent. Subretinal fluid (17%) and drusen (17%) both appeared mildly hyperfluorescent.
Orange pigment was the most hyperfluorescent FAF finding. Because the presence of orange pigment is a known risk factor for malignant transformation, the use of camera-based FAF imaging may improve our ability to identify those choroidal nevi that will transform into malignant melanoma. More long-term follow-up studies will be required to determine the exact prognostic value of our findings.
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ABSTRACT: To report an eye with polypoidal choroidal vasculopathy (PCV) and a choroidal nevus. This is an observational case report. A healthy 69-year-old woman was referred to the Osaka University Hospital with a diagnosis of a macular tumor. She complained of having distorted vision in her left eye. The medical history of the patient was unremarkable. At the initial examination, her best-corrected visual acuity (BCVA) was 20/20 in both eyes, and the intraocular pressure was 18 mm Hg in both eyes. A slit-lamp examination showed no abnormalities in the anterior segment of both eyes and a fundus examination of the left eye showed a slightly elevated juxtafoveal chorioretinal lesion and polyp-like reddish-orange lesions. The juxtafoveal choroidal lesion was located beneath a choroidal neovascularization (CNV). An optical coherence tomography confirmed CNV with pigment epithelial detachment (PED). Fluorescein angiography showed juxtafoveal hyperfluorescence due to CNV. Indocyanine green angiography demonstrated a branching choroidal vascular network that resembled polypoidal lesions. A fundus autofluorescence showed a mosaic pattern and a slight hyperautofluorescence at the CNV. We diagnosed the patient as having PCV. Aflibercept was injected intravitreally because of her PED. After the injection, PED improved and her visual acuity remained stable during the 12-month follow-up period. In cases of PCV, FAF images are helpful in determining the status of the posterior pole. Intravitreal injections of aflibercept can improve PED associated with CNV, and the BCVA will remain stable for at least 12 months.
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ABSTRACT: AIM: To evaluate the diagnostic properties of wide-field fundus autofluorescence (FAF) scanning laser ophthalmoscope (SLO) imaging for differentiating choroidal pigmented lesions. METHODS: A consecutive series of 139 patients were included, 101 had established choroidal melanoma with 13 untreated lesions and 98 treated with radiotherapy. Thirty-eight had choroidal nevi. All patients underwent a full ophthalmological examination, undilated wide-field imaging, FAF and standardized US examination. FAF images and imaging characteristics from SLO were correlated with the structural findings in the two patient groups. RESULTS: Mean FAF intensity of melanomas was significantly lower than the FAF of choroidal nevi. Only 1 out of 38 included eyes with nevi touched the optic disc compared to 31 out of 101 eyes with melanomas. In 18 out of 101 melanomas subretinal fluid was seen at the pigmented lesion compared to none seen in eyes with confirmed choroidal nevi. In "green laser separation", a trend towards more mixed FAF appearance of melanomas compared to nevi was observed. The mean maximal and minimal transverse and longitudinal diameters of melanomas were significantly higher than those of nevi. CONCLUSION: Wide-field SLO and FAF imaging may be an appropriate non-invasive diagnostic screening tool to differentiate benign from malign pigmented choroidal lesions.International Journal of Ophthalmology 08/2014; 7(4):697-703. DOI:10.3980/j.issn.2222-3959.2014.04.21 · 0.12 Impact Factor
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ABSTRACT: PURPOSE: To present the American Brachytherapy Society (ABS) guidelines for plaque brachytherapy of choroidal melanoma and retinoblastoma. METHODS AND MATERIALS: An international multicenter Ophthalmic Oncology Task Force (OOTF) was assembled to include 47 radiation oncologists, medical physicists, and ophthalmic oncologists from 10 countries. The ABS-OOTF produced collaborative guidelines, based on their eye cancerespecific clinical experience and knowledge of the literature. This work was reviewed and approved by the ABS Board of Directors as well as within the journal’s peer-reivew process. RESULTS: The ABS-OOTF reached consensus that ophthalmic plaque radiation therapy is best performed in subspecialty brachytherapy centers. Quality assurance, methods of plaque construction, and dosimetry should be consistent with the 2012 joint guidelines of the American Association of Physicists in Medicine and ABS. Implantation of plaque sources should be performed by subspecialty-trained surgeons. Although there exist select restrictions related to tumor size and location, the ABS-OOTF agreed that most melanomas of the iris, ciliary body, and choroid could be treated with plaque brachytherapy. The ABS-OOTF reached consensus that tumors with gross orbital extension and blind painful eyes and those with no light perception vision are unsuitable for brachytherapy. In contrast, only select retinoblastomas are eligible for plaque brachytherapy. Prescription doses, dose rates, treatment durations, and clinical methods are described. CONCLUSIONS: Plaque brachytherapy is an effective eye and vision-sparing method to treat patients with intraocular tumors. Practitioners are encouraged to use ABS-OOTF guidelines to enhance their practice.Brachytherapy 12/2013; DOI:10.1016/j.brachy.2013.11.008 · 1.99 Impact Factor