Abstract
Purpose: :
Choroidal tumours are associated with several degenerative changes in the overlying tissues. These changes have been called "Tumour-Associated Retinal Pigment Epitheliopathy" (TARPE). The presence of lipofuscin (orange pigment) is a sign of retinal pigment epithelial distress. The purpose of this study is to describe short-wavelength fundus autofluorescence (SW-FAF) and near-infrared reflectance (IRR) findings in choroidal tumors.
Methods: :
Retrospective chart review of 44 consecutive patients with choroidal tumors who underwent SW-FAF and IRR photography. The correlation between SW-FAF and IRR patterns and foci of orange pigment, hyperpigmentation, drusen, fibrous metaplasia and subretinal fluid, was evaluated.
Results: :
The mean patient age was 65. Twenty-nine patients had a choroidal melanoma, 9 patients had choroidal metastasis, and 6 patients had a choroidal hemangioma. All tumors showed many foci of increased SW-FAF and/or increased IRR. Orange pigment displayed the brightest SW-FAF and was hyperreflective in IRR imaging. IRR imaging highlighted the presence of condensed clumps of orange pigment, presenting a good correlation with SW-FAF imaging, but barely detected diffuse fine lipofuscin. Related RPE hyperplasia and atrophy were isoreflective with the normal fundus, showing low correlation with SW-FAF, where they appeared mainly hypofluorescent. Lipid exudates and drusen were hyperreflective in IRR imaging and difficult to distinguish from the orange pigment, creating a "confusion factor". Fibrous metaplasia was mainly hyperreflective while it was hypofluorescent in SW-FAF imaging. Subretinal fluid was barely visible in IRR imaging, while SW-FAF imaging highlighted its presence. The top of dome-shaped surfaces in the fundus were usually hyperreflective, creating an artifact that didn't exist in SW-FAF imaging.
Keywords: oncology • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) • ipofuscin