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Johnny Tang, Debarshi Mustafi, Virginia M. Utz; Spectral Domain Optical Coherence Tomographic Findings In Choroidal Melanocytic Lesions. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2212.
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To compare detection rates of drusen and subretinal fluid by spectral domain optical coherence tomography (SD OCT) as compared to ophthalmoscopy and fundus photography in cases of choroidal melanocytic lesions referred to the VA Medical Center from community primary vision care centers.
In a consecutive case series of 6 patients with choroidal melanocytic lesions that would have been categorized as a small or medium tumor according to the size-based nomenclature used in the Collaborative Ocular Melanoma Study, each eye was submitted to ophthalmoscopic examination, fundus photography and SD OCT. The presence of drusen, subretinal fluid (SRF) and orange pigment was recorded for each lesion on based on ophthalmoscopy and fundus photographs. SD OCT images were reviewed in all cases in a masked fashion. The presence of drusen and SRF detected on ophthalmoscopy and fundus photography were compared to SD OCT findings.
The ophthalmoscopic examination revealed drusen in 66% and subretinal fluid in 0 % of cases. SD-OCT detected drusen in 50% and subretinal fluid in 66% of cases. Orange pigment was present in 50% of the cases on review of fundus images, although this was not detailed in the clinical exam note prior to consultation with a retina specialist.
D OCT imaging complements the clinical examination by verifying and documenting retinal and RPE changes associated with choroidal melanocytic lesions. In small and inderterminate lesions, the ability of SD OCT enhances the detection rate of sub-retinal fluid. In the community setting, where patients are not evaluated by retina or ocular oncology specialists, this modality becomes of increased importance to detect high risk features and to promptly refer. Once validated in a larger number of patients, SD OCT can be incorporated into diagnostic algorithms.
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