Sclerochoroidal calcifications imaged using enhanced depth imaging optical coherence tomography.

PURPOSE: To report a case of sclerochoroidal calcifications and describe the appearance of these lesions using optical coherence tomography with enhanced depth imaging (EDI-OCT) technology. DESIGN: Case Report METHODS: An 85-year-old patient who presented with bilateral retinal lesions suspected to be metastases was evaluated with slit-lamp biomicroscopy, funduscopy, fluorescein angiography, B-scan ultrasonography (U/S), and EDI-OCT. RESULTS: B-scan U/S demonstrated echo-dense consolidations in the choroid bilaterally with acoustic shadowing consistent with sclerochoroidal calcifications. EDI-OCT revealed hyper-reflective lesions with decreased reflectivity posterior to the lesion. CONCLUSIONS: Sclerochoroidal calcifications should be included in the differential of choroidal masses, given their unique appearance on EDI-OCT.

Confirmation of and differentiation among primary vascular lesions using ultrasonography.

PURPOSE: To demonstrate the utility of orbital ultrasound in the evaluation and management of suspected orbital vascular lesions. METHODS: Clinical case series of 15 patients with suspected orbital vascular lesions seen in the Neuro-ophthalmology clinic of the Wilmer Eye Institute. The techniques of standardized echography (combined use of a contact B-scan and standardized A-scan) were performed by an experienced echographer, and data obtained were compared with other available imaging modalities to determine appropriate management. Patients were monitored for improvement, stability, or worsening of symptoms and signs. RESULTS: Based on echographic data obtained, 6 patients underwent surgery, 9 were observed over a follow-up period of 0-14 (mean 3.3) years. All patients demonstrated improvement or remained stable, and no complications developed from misdiagnosis during subsequent follow-up. CONCLUSIONS: Orbital ultrasound provides reliable imaging parameters and can be used as the primary imaging modality when evaluating suspected orbital vascular lesions.

The suboptimal role of optical coherence tomography in diagnosing choroidal metastasis in the macula.

PURPOSE: To describe the clinical, optical coherence tomography, and echographic findings of a choroidal metastasis in the macula. An initial, erroneous diagnosis of a serous pigment epithelial detachment of the macula had been based on ophthalmoscopic and optical coherence tomography findings. METHODS: Case report of a patient with blurred vision in one eye and presumed serous pigment epithelial detachment. RESULTS: An 83-year-old man with blurred vision and presumed serous pigment epithelial detachment was self-referred to our clinic for a second opinion. Optical coherence tomography showed an elevation of the neurosensory macula, but no abnormalities were reflected from the choroid. We performed an ultrasound evaluation, which revealed a solid mass involving the macular region of the choroid. The echo-graphic characteristics, including low internal reflectivity, regular structure, and vas-cularity, were consistent with choroidal melanoma or metastasis from any small cell carcinoma. The patient was not aware of any active primary tumor. An extensive systemic workup was performed. His prostate-specific antigen was found to be elevated to 61.4 ng/mL, and a prostate biopsy was positive for adenocarcinoma. Additional studies revealed metastatic disease involving the bones, pulmonary parenchyma, and mediastinal and retroperitoneal lymph nodes. CONCLUSION: Ultrasound imaging was superior to optical coherence tomography imaging in the clinical setting of a choroidal mass in the macula.

Ultrasound features of orbital granular cell tumor.

The authors report the echographic characteristics of a rare orbital granular cell tumor and correlate these findings with histopathology. A 56-year-old woman presented with proptosis. Complete ophthalmic and ultrasound examinations were performed. Ultrasound revealed an oval, well-outlined orbital mass in the intraconal space with low-medium reflectivity and regular internal structure. An orbitotomy with complete excision of the tumor was performed. Histopathologic evaluation showed sheets and nests of cells with abundant eosinophilic and granular cytoplasm in a uniform distribution throughout the lesion. The echographic characteristics correlated well with the morphologic surgical findings and the histologic architecture. This is the first report describing the echographic characteristics of orbital granular cell tumor.

Epibulbar foreign body granuloma masquerading as extrascleral extension following brachytherapy for choroidal melanoma.

PURPOSE: To describe a patient with epibulbar foreign body granuloma following brachytherapy for choroidal melanoma and to illustrate the echographic features that aided in the differential diagnosis. METHODS: Observational case report. Patient had multiple clinical exams over time to evaluate a treated choroidal melanoma. PATIENTS: A 61-year-old man presented for echographic follow-up examination following treatment for choroidal melanoma. An epibulbar lesion was noted adjacent to the site of the previously treated choroidal melanoma. Incisional biopsy and histologic evaluation were required. RESULTS: Ultrasonography revealed regression of the intraocular tumor; however, an oval epibulbar mass with irregular internal structure, irregular reflectivity, and no vascularity was noted. The echographic features were not typical of extrascleral extension of choroidal melanoma. Histopathologic evaluation showed fibrous connective tissue with an intense infiltrate of histiocytes with occasional giant cells and rare birefringent foreign body materials. CONCLUSION: Foreign body granuloma should be considered in the echographic differential diagnosis of an atypical extrascleral lesion following uveal melanoma brachytherapy.

Prevalence of cystoid macular edema and stability in oct retinal thickness in eyes with retinitis pigmentosa during a 48-week lutein trial.

PURPOSE: To describe, in a group of patients with moderately advanced retinitis pigmentosa (RP), the prevalence of cystoid macular edema (CME), the variation in foveal thickness over a 48-week period, the correlation of visual acuity (VA) with retinal thickness, and the lack of response of CME to lutein administration. METHODS: Optical coherence tomography (OCT) imaging of the macula and clinical examination were evaluated for 77 eyes of 39 patients with RP over 11 months, with a scan done every 6 weeks. RESULTS: The prevalence of CME, defined by cysts visible on OCT, was 49%. Bilateral CME was present in 44% of patients (17 of 39), and an additional two patients had unilateral CME. Central retinal thickness varied little over the 48 weeks. Sixty-six percent of the eyes with CME had VA of 20/40 or better. The eyes with CME with VA worse than 20/40 had either greater degrees of thickening or in fact had lower thickness measures. For the eyes without CME, the eyes with VA worse than 20/40 tended to have lower retinal thickness than the eyes with VA of 20/40 or better. VA was highly concordant between eyes, and did not differ significantly between the groups with and without CME. Lutein did not show a statistically significant effect on retinal thickness in the patients with or without CME, nor was such an effect observed in subgroups of patients with vision better or worse than 20/40. CONCLUSION: The prevalence rate of CME is higher than in previous reports, perhaps because the patients had some preserved macular vision and because of the use of a definition based on OCT findings. Retinal thickness remains fairly stable over time, both in eyes with CME and in eyes without CME.