Photoreceptor Arrangement Changes Secondary to Choroidal Nevus.

IMPORTANCE: Although mostly asymptomatic, patients with choroidal nevi carry a moderate risk for malignant transformation and visual loss. A novel noninvasive imaging assessment could change the current clinical evaluation of choroidal nevi. OBSERVATION: Three patients with a recent diagnosis of choroidal nevi underwent a novel adaptive optical assessment that detected potential photoreceptor abnormalities in the retina overlying the choroidal nevi. CONCLUSIONS AND RELEVANCE: Adaptive optics imaging may provide high-resolution en face images of retinal structural changes in the photoreceptor mosaic overlying the choroidal nevi. Cone attenuation may be an important component of structural damage in choroidal nevi and may correlate and possibly predict functional visual loss.

SUBMILLIMETER CHOROIDAL MELANOMA DETECTION BY ENHANCED DEPTH IMAGING OPTICAL COHERENCE TOMOGRAPHY IN A PATIENT WITH OCULODERMAL MELANOCYTOSIS.

PURPOSE: To describe a tiny subclinical choroidal melanoma visualized only with enhanced depth imaging optical coherence tomography in a newly symptomatic patient with known oculodermal melanocytosis. METHODS: Case report. RESULTS: A 52-year-old white man with heterochromia and known oculodermal melanocytosis of the right eye, followed for 2 years without change, developed blurred vision and was referred for possible central serous chorioretinopathy. On examination, visual acuity was 20/20 in each eye. There was oculodermal melanocytosis in the right eye involving the periocular skin, episclera, iris, and choroid. On ophthalmoscopy and ocular ultrasonography, there was no appreciable mass, but subtle subfoveal fluid and perifoveal orange pigment were detected, as well as equatorial drusen. Enhanced depth imaging optical coherence tomography demonstrated a subtle optically dense focal choroidal mass measuring 4.5 mm in basal dimension and 0.7 mm in enhanced depth imaging optical coherence tomography thickness. There was choroidal vascular compression, obliteration of choroidal details, and related overlying subretinal fluid with shaggy photoreceptors, consistent with early choroidal melanoma in an eye with oculodermal melanocytosis. The patient elected early treatment considering the risk factors for growth and the risk for metastasis associated with melanoma in the setting of oculodermal melanocytosis. Plaque radiotherapy was performed with complete tumor regression clinically and by enhanced depth imaging optical coherence tomography. At 2-year follow-up, visual acuity remains 20/20, with regressed tumor and no systemic metastasis. CONCLUSION: Enhanced depth imaging optical coherence tomography is a useful tool in the evaluation of eyes with oculodermal melanocytosis, permitting high-resolution visualization of the choroid and detection of submillimeter early melanoma that might not be apparent with indirect ophthalmoscopy or ultrasonography.