Abstract
Purpose :
To report the optical coherence tomography (OCT) findings of choroidal melanoma with subretinal fluid.
Methods :
This is a single center, retrospective review of spectral domain OCT images of treatment naïve choroidal melanoma cases with associated subretinal fluid, presenting between July 2009 and August 2021. Demographic characteristics and tumor features were reviewed. Tumors were grouped according to Collaborative Ocular Melanoma Study (COMS) categories. OCT features were categorized as elongated photoreceptors, photoreceptor/ellipsoid zone (EZ) loss, retinal pigment epithelium (RPE) loss, RPE hyperplasia, intraretinal fluid, retinoschisis (inner layer, outer layer, or both), pigment epithelial detachment (PED), retinal thinning, outer plexiform layer (OPL) splitting, bacillary layer detachment (BALAD) (horizontal, circular or both), and subretinal hyperreflective material (SRHM) (homogenous, heterogenous or both). Statistical analysis was performed using SPSS Statistics Software Version 28 (IBM, Armonk, New York).
Results :
OCT features of 236 patients, from the most to least common included: photoreceptor and/or EZ loss or disruption in 174 (73.7%), RPE hyperplasia in 153 (64.8%), photoreceptor elongation in 118 (50.0%), macular subretinal fluid in 92 (39.0%), intraretinal fluid in 84 (35.6%), heterogenous SRHM in 72 (30.5%), BALAD in 67 (28.4%), RPE loss or disruption in 67 (28.4%), retracted photoreceptors in 56 (23.7), retinal thinning in 50 (21.2%), OPL splitting in 50 (21.2%), homogenous SRHM in 48 (20.3%), PED in 38 (16.1%), and retinoschisis in 5 (2.1%) patients. Photoreceptor/EZ loss increased progressively with small vs. medium vs. large tumors (52.0% vs. 86.9% vs. 94.9%, p<0.001), and this difference remained significant when further analyzed with subretinal fluid extent as a confounder (p<0.001). BALAD was more common in medium compared to small melanomas and was associated with greater extent of subretinal fluid. This difference remained significant when subretinal fluid was considered as a confounding variable (p=0.006).
Conclusions :
Choroidal melanoma-associated subretinal fluid has many unique OCT features including BALAD and SRHM. Future longitudinal studies are needed to evaluate the diagnostic and prognostic importance of these findings in patients with choroidal melanoma.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.