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R. D. Vincent, V. A. Shah, K. Desai, G. Gallimore, M. Rupani; Documentation of Optic Disc Melanocytoma by Spectral and Time Domain Optical Coherence Tomography. Invest. Ophthalmol. Vis. Sci. 2008;49(13):902.
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Optical coherence tomography (OCT) is increasingly used in various retinal disorders due to its user friendly high resolution imaging capabilities. Our purpose of this report is to present spectral domain and time domain OCT findings in a patient with optic nerve head melanocytoma.
A 55 year old African American male was referred to the oncology service for evaluation of possible melanocytoma of optic nerve head OS. Dilated fundus exam revealed cup to disc ratio of 0.8 OD and 0.75 OS with the rest of the fundus normal OD. OS revealed a flat densely pigmented lesion adjacent to the optic disc inferotemporally suggestive of melanocytoma. Fluorescein angiography revealed a darkly pigmented lesion blocking choroidal circulation with overlying normal retinal vasculature.
Optical coherence tomography (OCT) with both time domain stratus OCT and the spectral domain OCT (SLO/OCT, Ophthalmic Technologies Inc) through the area of melanocytoma revealed hyper-reflective retinal thickening in the location. In certain areas of the tumor, hyper-reflective signal characteristics were similar to that of adjacent retinal nerve fiber layer. This is consistent with previous reports for time domain optical coherence tomography of melanocytoma. Both OCT’s also demonstrated higher reflectivity and focal thickening of the retinal pigment epithelium layer with optical shadowing.
To the best of our knowledge this is the first report of spectral domain OCT findings of melanocytoma and its comparison with the standard time domain OCT. Both OCT’s demonstrated higher reflectivity and focal thickening of the retinal pigment epithelium layer with optical shadowing. This particular finding has not been mentioned in previously published reports in the literature. We hypothesize this could be due to a reactionary hyperplasia of the retinal pigment epithelium or due to the densely packed collections of migrated uveal melanocytes at the retinal pigment epithelium.
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