[Transformation of choroidal nevus into melanoma]. / Transformatsiya nevusa khorioidei v melanomu.

The risk of choroidal melanoma developing from choroidal nevus (CN) varies in range of 0.78-7%. Absence of a common terminology and distinct diagnostic criteria characterizing small melanoma de novo and unusual CN often complicates treatment choice and patient prognosis. PURPOSE: To study the clinical features and the role of visualization methods in the diagnosis of CN transformation into melanoma. MATERIAL AND METHODS: The study analyzes the clinical picture and visualization results of 11 patients with initial diagnosis of «choroidal nevus¼ (n=3) and «suspicious choroidal nevus¼ (n=8). RESULTS AND DISCUSSION: Examination and continued observation revealed 7 patients to have melanoma that had developed from CN (2 of them confirmed with histological studies). The time before CN transformed into melanoma varied between 4 and 13 years, with median 5 [4; 12] years. Two patients were diagnosed with primary melanoma (melanoma de novo), two other patients - with suspicious CN. In progressive CN transforming into melanoma, visual impairments occurred between 6 months and 13 years in 6 out of 7 patients. Initial prominence of suspicious CN at the first visit was 1.9±0.68 mm (0.9 mm to 2.67 mm). The characteristic features of suspicious CN transforming into initial melanoma are: 1) asymmetric shape of the edges of expanded choroidal complex; 2) presence of areas of damaged choriocapillaris layer, direct and indirect signs of loss of integrity of the Bruch's membrane; 3) areas of accumulation of moderately hyperreflective subretinal exudate; 4) presence of intraretinal hyperreflective inclusions. The signs distinguishing primary choroidal melanoma from melanoma that had developed from CN are: 1) absence of areas with tomography pattern characteristic of nevi; 2) more pronounced asymmetry of the shape of edges, compared to melanoma developed from CN; 3) presence of cysts in larger tumors, compared to melanoma developed from CN. CONCLUSION: All patients with CN should be regularly followed up by an ophthalmologist.

[Choroidal melanoma and retinal changes]. / Melanoma khorioidei i izmeneniia setchatki.

Literary sources suggest the existence of a new phenotype - retinoinvasive choroidal melanoma (CM). However, the factual evidence of its spreading over the inner retinal surface cannot be dismissed. PURPOSE: To study the capabilities of optical coherence tomography (OCT) in terms of finding the ways CM spreads into the retina based on pathomorphological examination of the eyes enucleated due to CM. MATERIAL AND METHODS: OCT tomograms of 64 eyes with CM (mean tumor elevation - 2.89±0.19 mm, diameter - 9.58±0.43 mm) were studied. Pathomorphological study was conducted on 18 eyes with CM elevated by up to 7 mm and without previous treatment. RESULTS: OCT revealed signs of melanoma invading into the retina in 49 eyes. Among those signs were: presence of retina/CM aggregation (21 eyes), tearing of Bruch's membrane and retinal pigment epithelium, disturbed differentiation of outer retinal layers (15 eyes). Combination of two types of invasion was found in 11 eyes. Pathomorphological study showed low mitotic activity of CM and the presence of a small number of fine-local necroses and hemorrhages. Invasion of CM into the retina was determined in 13 eyes. Retinal invasion began with local destruction of Bruch's membrane (BM) and was often limited by the photoreceptor level, disturbing architectonics of the retina and nuclear layers. Large CMs were accompanied by rough destruction of the Bruch's membrane, tumor cells - in the edematous retina with cystoid dystrophy, in its inner layers, invading into the vitreous body. Infiltration of the retina to inner nuclear layer was accompanied by its transudative detachment and cystoid dystrophy. CONCLUSION: Invasion of CM into the retina affecting all of its layers imposes use of OCT to examine the integrity of the retina, even with a tumor of small thickness. Tumoral infiltration of the retina and localization of tumor near the optic disc are two contraindications for local endovitreal resection. Brachytherapy requires consideration of tumor characteristics and thickness of the retina for calculation of apical radiation dose.

[Morphogenesis of choroidal melanomas in OCT imaging]. / Morfogenez melanom khorio-idei v svete opticheskoi kogerentnoi tomografii.

When planning conservation therapy for choroidal melanoma (CM), evaluation of its size and stage is done using various methods of visualization, among which is optical coherence tomography (OCT). A recently introduced modification of OCT - Enhanced Depth Imaging (EDI) allows observation of deep choroid and sclera. PURPOSE: To specify clinicomorphologic correlations between OCT signs related to CM and its pathomorphological state as described in literature. MATERIAL AND METHODS: The study included 33 patients with predominantly small CM who were examined with EDI-OCT. RESULTS: The following surface profiles were revealed: small and medium sized CM with even and uneven surface and with a plateau on the top; medium sized CM with flattened edge. Bruch's membrane (BM) had folds along the tumor edge in medium and big CM. In mushroom-shaped CM, extended defective areas could be observed. Increase of optical density in the inner parts of choroidal complex were seen over time. In CM of 2.9 mm and less, cavities were observed in the middle layers of choroid in the tumor area. In roughly half of the cases, vascular distention was seen in choroid in the tumor periphery. Changes of retinal pigment epithelium (RPE) included its thickening and presence of hyperreflective foci. In CM with prominence of more than 2.17 mm at the top, the changes included the formation of a 'single unitary block' at the level of BM/RPE and neurosensory retinal layers. Intraretinal cysts could be seen on top of the tumor at the level of outer retinal layers in CM with prominence of more than 1.5 mm. CONCLUSION: Comparison of OCT images of CM with various biometric parameters with literature data on pathomorphological changes helped specify early pathomorphological symptoms in perifocal choroid (a feature of initial CM) and highly dynamic phasing of secondary changes in the retina.

[Diagnostic potential of optical coherence tomography for small choroidal melanomas]. / Opticheskaya kogerentnaya tomografiya v diagnostike nachal'nykh melanom khorioidei.

AIM: To investigate the sequence of OCT manifestations in choroidal melanoma (CM) with account to its growth. MATERIAL AND METHODS: A total of 28 CM patients were examined. Of them, 18 patients with early CM, 10 - with medium-sized CM. The mean patient age at diagnosis was 60.54±5.31 years. Tumor location was macular (15 eyes) or perimacular (13 eyes), its prominence varied from 0.98 to 4.9 mm and basal diameter - from 5.08 to 18.9 mm. Additionally to OCT, tumor autofluorescence was studied in all cases. RESULTS: The sequence of OCT manifestations in CM has been investigated with account to its growth. Our findings include an early change in choroidal profile with often uneven configuration and a plateau in the most prominent part of the lesion. Along with changes in the retinal pigment epithelium (RPE), one could see signs of an initially local small neuroepithelial detachment (NED) with alterations in the photoreceptor layer. We have identified three types of photoreceptor damage. Destruction of all retinal layers (its morphofunctional disorder) indicates the transition of an early CM to a medium one. As to autofluorescence RESULTS: there were lipofuscin deposits in RPE cells detected in OCT scans that showed an evident hyperautofluorescence. The central part the tumor was notable for its hypoautofluorescence. The periphery of the lesion was hyperautofluorescent due to NED. CONCLUSION: Qualitative changes in the retina overlying choroidal melanoma develop early in the course of the disease, practically in the moment of the first shift of choroidal profile. Destruction begins with the RPE and neuroepithelium (detachment and structural changes). As the tumor grows, retinal architectonics gets irreversibly distorted: the tissue becomes thicker due to edema, cysts, and intraretinal deposits. This process is, of course, accompanied by changes in metric parameters of all retinal layers and the choroid within the area of interest.

[Precise diagnosis of choroidal hemangioma]. / Gemangioma khorioidei i vozmozhnosti ee utochnennoi diagnostiki.

AIM: to determine potential benefits of optical coherence tomography (OCT) for precise diagnosis of choroidal hemangioma (CH). MATERIAL AND METHODS: A total of 27 patients (22 women, 5 men) with unilateral CH were examined. The age at diagnosis ranged from 30 to 76 years and averaged 53.7±5.29 years. Tumor thickness varied from 0.9 to 5.3 mm (2.17±0.41 mm; median of 1.9 mm), basal diameter - from 2.64 to 13.86 mm (median of 7.7 mm). RESULTS: Having analyzed OCT findings in CH patients, we came to the conclusion that retinal architectonics does not get distorted (like in cystic dystrophy, for example) before the tumor prominence reaches 1.8 mm. As to retinal edema, it is associated with even greater tumor thicknesses. It should be also noted that any of the CH-related morphofunctional changes in the retina take a really long time to progress. At autofluorescence assessment, choroidal hemangioma had the appearance of a large hypoautofluorescent spot. Areas of fibrosis as well as hyperplasia or atrophy of the retinal pigment epithelium (RPE) also exhibited hypoautofluorescence. Sites of hyperautofluorescence corresponded to lipofuscin deposits. In two cases, there were wide zones of moderate hyperautofluorescence around the tumor due to recent subretinal effusion and photoreceptor damage. Hypoautofluorescent spots within these hyperautofluorescent areas corresponded to RPE atrophy by OCT. CONCLUSION: Ophthalmoscopic presentation of choroidal hemangioma may be not comprehensive enough; therefore modern diagnostic methods, such as widely accepted fluorescence angiography and also spectral OCT (especially, in the «deeper penetration mode¼ for examination of the choroid) and autofluorescence assessment in the MultiColor mode may be used to ensure a more precise diagnosis.

[Diagnostic approach to choroidal metastases]. / Diagnostika khorioidal'nykh metastazov.

Intraocular metastases account for 64-67% of all metastatic ocular tumors, of them 88-90.7% are found in the choroid. By the time the metastasis is diagnosed, 30-44% of patients usually have their primary lesion identified. In oncology patients with multiple and/or bilateral choroidal involvement, the diagnosis can be easily determined at ophthalmoscopy, while in those whose anamnesis is unburdened, this task is quite challenging. Aim - to define diagnostic criteria of choroidal metastases that would consider data provided by state-of-the-art instrumental assessment. MATERIAL AND METHODS: The study enrolled 5 patients (3 women and 2 men) with choroidal metastases of different origin. The mean patient age at the time of ocular involvement was 47.8 years (38-60 years). Oncological anamnesis was burdened in only 2 cases. RESULTS: Due to the small number of cases and diverse clinical presentation, we considered appropriate to describe each case separately. CONCLUSION: The absence of a known pre-existing lesion is typical of the younger age group. By analyzing optical coherence tomography data, we are able to list the most common signs of all choroidal metastases: hummocky profile of the choroid and a high neuroepithelium detachment accompanied by edema and photoreceptor damage. Fluorescein angiography diagnostic criteria are the following: spotted hyperfluorescence that begins in the arterial phase and gradually increases in intensity, while choroidal fluorescence is blocked during the whole examination; almost confluent hyperfluorescence with brighter pin-points along the margin of the lesion seen in the later phases. Evaluation of autofluorescence is auxiliary, but can provide an idea of the disease duration.