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R. N. Belfort, K. Sayanagi, P. K. Kaiser, A. D. Singh; Spectral Domain OCT and Autofluorescence of 50 Choroidal Melanocytic Lesions. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5233.
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To compare clinical findings with fundus autofluorescence (AF) and optical coherence tomography (OCT) in patients with choroidal melanocytic lesions. Fundus AF and OCT may be helpful in differentiating nevus from small choroidal melanoma by assessing associated retinal and retinal pigment epithelial changes.
After IRB approval, 50 consecutive patients with choroidal melanocytic lesions were prospectively included in the study. Tumors were classified based on indirect ophthalmoscopy and ultrasound as nevus, indeterminate melanocytic lesion (IML) or melanoma. All patients underwent detailed ophthalmoscopic examination, ultrasonography, fundus photography, fundus AF, and spectral domain (SD) OCT (Spectralis HRA+OCT; Heidelberg Engineering, Germany) of the melanocytic lesion. For comparison, time-domain (TD) OCT (Stratus OCT-3, Carl Zeiss Meditec, Dublin, CA) was also performed in select cases.
Out of the 50 patients, 9 were classified as nevus, 30 as IML and 11 as melanomas. Out of the 30 IML, 11 had drusen and 17 had orange pigment. All the lesions that presented with orange pigment were hyper AF (plus 2 other cases that were clinically negative). SRF was observed in 18 IML on ophthalmoscopy and in 20 by SD-OCT. In 3 cases, drusen were identifiable only on SD-OCT. Out of the 13 IML lesions examined by both TD-OCT and SD-OCT, 8 revealed SRF by TD-OCT, 9 by SD-OCT and 9 by ophthalmoscopy.
SD-OCT is more sensitive than TD-OCT and ophthalmoscopy in demonstrating drusen and SRF. Fundus AF is as sensitive as ophthalmoscopy in demonstrating orange pigment. SD-OCT is a useful imaging technique in detecting known high risk features of choroidal melanocytic lesions.
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