Measurement of size of pigmented choroidal nevus: Superiority of multicolor imaging compared to conventional color fundus photography

Choroidal nevi are benign fundus lesions that require regular follow with documentation. Conventional color fundus photography (CFP) has traditionally been used to images these lesions. Multicolor imaging (MCI) available on Spectralis spectral domain optical coherence tomography system is increasingly been tested vis-à-vis conventional CFP in various retinal diseases. We present data of the right eye of a 59-year-old gentleman with choroidal nevus who underwent conventional CFP as well as MCI. Nevus appeared orange red on MCI and its size appeared larger than the same measured on conventional CFP. We also report infrared reflectance and near infrared autofluorescence features of choroidal nevus.

Enhanced Depth Imaging Optical Coherence Tomography of Choroidal Nevus : Comparison to B-Scan Ultrasonography

PURPOSE: To evaluate the characteristics of choroidal nevus using the enhanced depth imaging spectral domain optical coherence tomography (EDI SD-OCT), with a comparison to the B scan ultrasound (BUS) findings. METHODS: Medical records of 124 eyes of 124 choroidal nevus patients were reviewed retrospectively. All patients underwent fundus photography (FP), EDI SD-OCT, and BUS. RESULTS: Of 124 eyes with choroidal nevus examined by EDI SD-OCT, 43 eyes (35%) displayed good images to study. The most common EDI-OCT imaging features included choroidal shadowing, choriocapillary thinning, retinal pigment epithelial changes, and overlying subretinal fluid. The mean nevus thickness was 817 microm (120-1850 microm) by EDI-OCT compared 1295 microm (780-2400 microm) by BUS. The mean difference in the tumor thickness between two techniques was 475 microm (27-1319 microm) (p < 0.05). CONCLUSIONS: These results have suggested that imaging of choroidal nevus with EDI-OCT shows superior measurement of its characteristics compared with ultrasonography. The clinical utility of this modality is emerging. EDI-OCT is useful in distinguishing suspicious nevi from other chorioretinal lesions, detecting tumor re-growth along the treatment margin, and demonstrating retinal or choroid tumor location.

Choroidal neovascularization secondary to choroidal nevus simulating an inflammatory lesion.

Choroidal nevi are the most common benign pigmented lesions of the fundus. Choroidal neovascularization is a rare complication of choroidal nevi. We report herein a young patient managed successfully with intravitreal bevacizumab injections for juxtapapillary choroidal neovascularization secondary to choroidal nevus simulating an inflammatory lesion.

In vivo sectional imaging of the retinal periphery using conventional optical coherence tomography systems.

Optical coherence tomography (OCT) has transformed macular disease practices. This report describes the use of conventional OCT systems for peripheral retinal imaging. Thirty-six eyes with peripheral retinal pathology underwent imaging with conventional OCT systems. In vivo sectional imaging of lattice degeneration, snail-track degeneration, and paving-stone degeneration was performed. Differences were noted between phenotypes of lattice degeneration. Several findings previously unreported in histopathology studies were encountered. Certain anatomic features were seen that could conceivably explain clinical and intraoperative behavior of peripheral lesions. Peripheral OCT imaging helped elucidate clinically ambiguous situations such as retinal breaks, subclinical retinal detachment, retinoschisis, choroidal nevus, and metastasis. Limitations of such scanning included end-gaze nystagmus and far peripheral lesions. This first of its kind study demonstrates the feasibility of peripheral retinal OCT imaging and expands the spectrum of indications for which OCT scanning may be clinically useful.

Fluorescein and Indocyanine Green Angiography of Choroidal Tumors

Fluorescein angiography (FAG) has been widely used in the diagnostic evaluation of choroidal tumors. Indocyanine green angiography (ICGA), which permits better visualization of choroidal vasculature than FAG, has been recently introduced into clinical practice. FAG and ICGA of 13 patients with choroidal tumors were assessed. These included 4 patients with choroidal nevus,4 with malignant melanoma, 2 with metastatic choroidal tumor,and 3 with choroidal hemangioma. In choroidal nevus, ICGA showed persistent hypofluorescence with clear delineation of the lesion in the late phase. Characteristic fluorescein angiographic feature of choroidal melanoma was hyperfluorescence in the late phase. However, the fluorescence of melanoma varied from hypo-,to hyperfluores- cent in the late phase of the ICGA. In choroidal metastatic tumor, FAG showed the typical pinpoint hyperfluorescence in the early phase and the diffuse leakage with serous detachment in the late phase. ICGA showed the hypofluo- rescence throughout the whole phases. In choroidal hemangioma, FAG and ICGA showed complete dye filling of the hemangioma with more denser hyperfluorescence in the early phase than in the late phase. In all patients, the lesion was better defined on the ICGA than on the FAG. This study suggests that ICGA combined with FAG may be useful in differentiating various choroidal tumors.