Fundus autofluorescence and optical coherence tomography findings in choroidal melanocytic lesions

To establish the characteristics of secondary retinal and retinal pigment epithelial [RPE] changes associated with the presence of choroidal melanoma and choroidal nevus as documented by optical coherence tomography [OCT] and fundus autofluorescence [FAF]. PubMed review of major English publications examining the correlation between clinical characteristics of choroidal melanoma and nevus with OCT and FAF findings. The intrinsic properties of choroidal melanoma, as well as overlying RPE changes, drusen, and lipofuscin are best characterized by FAF, while OCT is more sensitive for the identification of subretinal and intraretinal fluid as well as a trophy, degeneration, and photoreceptor loss in the neurosensory retina. Secondary retinal changes associated with choroidal melanocytic lesions can be documented by OCT and FAF. OCT evident changes are observed more often with choroidal melanoma than choroidal nevus. OCT is better suited to identify the overlying retinal detachment and edema, even before these findings are clinically apparent. FAF is most useful in documenting the presences of lipofuscin, a finding that represents one of the important criteria in differentiating small choroidal melanoma from benign choroidal nevus

Small choroidal melanoma with monosomy 3

To report a patient with small juxtapapillary choroidal melanoma with chromosome 3 monosomy treated with I[125] plaque and transpupillary thermotherapy [TTT]. A 64-year-old Caucasian male presented with painless blurred vision of the left eye. Ocular examination disclosed a small juxtapapillary choroidal melanocytic tumor with overlying subretinal fluid and orange pigment. Ultrasound showed an elevated choroidal mass of 2 mm thickness with low reflectivity on A-scan and hollowness on B scan, consistent with a small choroidal melanoma. The patient was treated with plaque I[125] radiotherapy combined with one session of TTT. Genetic testing of the tumor cells obtained by fine needle aspiration biopsy showed chromosome 3 monosomy. At 1 year after treatment, the tumor was regressed with resolution of subretinal fluid and 20/40 visual acuity. A small choroidal melanoma can manifest monosomy of chromosome 3, a known predictive factor for the development of systemic metastasis