RESUMO
Optical coherence tomography (OCT) is currently widely used for the diagnosis of choroidal melanoma (CM), but the problem of predicting the outcomes of planned CM treatment remains unsolved. PURPOSE: This study was conducted to identify OCT signs that adversely affect the outcome of organ-preserving CM treatment. MATERIAL AND METHODS: OCT scan images of 30 patients who underwent organ-preserving treatment and were under observation were selected for this study. Brachytherapy (BT) as monotherapy was performed in 27 patients (in 2 cases - twice, and in 1 case - three times), in one patient - in combination with the previous transpupillary thermotherapy (TTT). Multiple TTT (4 sessions within 4 months) as monotherapy were performed in 2 patients. In 9 cases, a single organ-preserving treatment (BT - 6 patients, TTT - 3 patients) was ineffective. In these cases, the effectiveness of the first stage of organ-preserving treatment was taken into account. RESULTS: Seven signs of an unfavorable prognosis of the performed treatment were identified by analyzis of tomograms and statistical processing of the obtained data. These signs include: the presence of intraretinal edema, detachment of the neuroepithelium (NED) over the tumor, including with a break in the photoreceptors, accumulation of transudate over the tumor, the presence of large cysts, intraretinal cavities and NED near the tumor (secondary retinal detachment). A combination of three or more signs were observed in all cases of inefficiency of the first stage of treatment. Most often, intraretinal edema and NED over the tumor were combined with the accumulation of subretinal transudate and NED near the tumor. The presence of 6 or all 7 signs took place in cases of a negative therapeutic effect after local destruction. CONCLUSION: When planning organ-preserving CM treatment, in addition to biometric parameters, it is necessary to pay special attention to the identification of such morphological signs as NED over and near the tumor, accumulation of transudate under the NED, the presence of intraretinal edema, large intraretinal cysts and cavities.
Assuntos
Braquiterapia , Neoplasias da Coroide , Melanoma , Tomografia de Coerência Óptica , Humanos , Tomografia de Coerência Óptica/métodos , Neoplasias da Coroide/terapia , Neoplasias da Coroide/diagnóstico , Melanoma/terapia , Melanoma/diagnóstico , Melanoma/diagnóstico por imagem , Masculino , Feminino , Pessoa de Meia-Idade , Braquiterapia/métodos , Prognóstico , Hipertermia Induzida/métodos , Resultado do Tratamento , Tratamentos com Preservação do Órgão/métodos , Adulto , Corioide/diagnóstico por imagem , Corioide/patologia , Idoso , Valor Preditivo dos TestesRESUMO
This case report presents the diagnostic features of isolated primary intraocular lymphoma, which was initially misdiagnosed as neovascular age-related macular degeneration. A comprehensive examination using ultrasound, optical coherence tomography, and fundus autofluorescence revealed changes characteristic of vitreoretinal lymphoma. Molecular genetic analysis of the vitreous body showed the presence of a MYD88 gene mutation and B-cell clonality by immunoglobulin heavy chain (IGH) gene rearrangement tests, which confirmed the diagnosis.
Assuntos
Neoplasias da Retina , Tomografia de Coerência Óptica , Corpo Vítreo , Humanos , Corpo Vítreo/patologia , Corpo Vítreo/diagnóstico por imagem , Neoplasias da Retina/diagnóstico , Tomografia de Coerência Óptica/métodos , Diagnóstico Diferencial , Linfoma Intraocular/diagnóstico , Masculino , Fator 88 de Diferenciação Mieloide/genética , Angiofluoresceinografia/métodos , Idoso , Neoplasias Oculares/diagnósticoRESUMO
Choroidal nevi (CN) are commonly divided into non-suspicious (stable) and suscpicious (progressive). However, there are still no clear data on OCT patterns of nevi progression, their transformation into initial melanomas. PURPOSE: The study aims to determine the types of OCT patterns of CN and to evaluate their prognostic value. MATERIAL AND METHODS: The study included 50 patients with CN (53 nevi). The height of 19 nevi evaluated with ultrasonography was 1.33±0.43 mm, diameter - 5.47±1.68 mm. RESULTS: CN is an area of local increase in reflectivity of the choroid; its widening and elevation of the tomographic section were observed in 72% of nevi. In more than half of all cases a distinct hyperreflective border was revealed between the CN and adjacent choroid. In two thirds of all cases the choriocapillaris layer was preserved and visualized mainly along the edge of lesion. Analysis of OCT scans showed distinct differences, which allowed designation of four OCT types of CN: 1) nevi with typical OCT pattern; 2) nevi with changes in retinal pigment epithelium (RPE); 3) nevi with neuroepithelial detachment; 4) nevi with atypical OCT pattern. CONCLUSION: Based on the analysis of OCT images of the determined types of nevi, it can be assumed that all of them initially had typical OCT pattern. With enlargement of the nevi and increase in the duration of its presence in the choroid, dystrophic processes in the adjacent retina and changes in RPE begin to occur. Disturbed pumping ability of the damaged RPE results in disruption of the trophism of adjacent retina, which leads to development of atrophic changes. Nevi with atypical OCT pattern should be considered as a sign of long-term benign process in the choroid that will cause atrophic changes in the choroid and adjacent retina, while nevi with changes in RPE and with neuroepithelial detachment - as a risk factor for transition to choroidal melanoma.
Assuntos
Neoplasias da Coroide , Nevo Pigmentado , Neoplasias Cutâneas , Humanos , Tomografia de Coerência Óptica/métodos , Neoplasias da Coroide/diagnóstico por imagem , Neoplasias da Coroide/patologia , Corioide/diagnóstico por imagem , Corioide/patologia , Nevo Pigmentado/diagnóstico por imagem , Nevo Pigmentado/patologia , Angiofluoresceinografia , Estudos RetrospectivosRESUMO
Cavernous hemangioma of the retina - a rarely occurring hamartoma that is predominantly found in the young age; it can be accompanied by cavernous hemangiomas of the skin and central nervous system. In Russian scientific literature this disease has not been described in sufficient detail. The article presents two clinical cases of incidentally diagnosed cavernous hemangioma of the retina. Multimodal diagnostics approach was used to confirm histological findings described in literature, which are characteristic of retinal cavernous hemangioma.
Assuntos
Hamartoma , Hemangioma Cavernoso , Humanos , Retina , Hemangioma Cavernoso/diagnóstico , Federação Russa , PeleRESUMO
Diagnosing pathologies of the ocular fundus and performing differential diagnosis of intraocular tumors along with conventional ophthalmoscopy can involve additional visualization methods such as ultrasonography, fluorescein angiography and optical coherence tomography (OCT). Many researchers note the importance of employing a multimodal approach in differential diagnosis of intraocular tumors, but there is no universally established algorithm for a rational choice of both the combination of visualizing methods, and the sequence of their application with consideration of the ophthalmoscopy findings and the results of first-line diagnostic methods. The article presents author's own multimodal algorithm developed for differential diagnosis of tumors and tumor-like diseases of the ocular fundus. This approach involves the use of such methods as OCT and Multicolor fluorescence imaging, with exact sequence and combination determined on the basis of ophthalmoscopy and ultrasonography findings.
Assuntos
Neoplasias da Coroide , Melanoma , Humanos , Fundo de Olho , Diagnóstico Diferencial , Oftalmoscopia , Neoplasias da Coroide/diagnóstico , Tomografia de Coerência Óptica/métodos , Angiofluoresceinografia/métodos , Estudos RetrospectivosRESUMO
The article presents five cases of various forms of hemangiomas of the optic nerve head (ONH) and juxtapapillary retina that were monitored and analyzed using ocular visualization methods. The obtained data allowed a conclusion that capillary hemangioma of the ONH features clearly-seen boundaries of the lesion both on ophthalmoscopy and optical coherence tomography (OCT) images; on the other hand, juxtapapillary granuloma can be characterized by blurred outlines on ophthalmoscopy and a gradual transition of the altered retina on OCT images with secondary changes seen in the macular area. When comorbid, capillary hemangioma of the ONH and retina feature a combination of these visualization signs.
Assuntos
Hemangioma Capilar , Disco Óptico , Hemangioma Capilar/patologia , Humanos , Oftalmoscopia , Disco Óptico/diagnóstico por imagem , Disco Óptico/patologia , Retina/patologia , Tomografia de Coerência Óptica/métodosRESUMO
Blood supply is known to be required for tumor growth and metastasis, and the formation of the tumor's own vasculature plays a critical role in the development of solid neoplasms. The method of optical coherence tomography angiography (OCTA) is considered promising for the study of angioarchitectonics. PURPOSE: To evaluate the OCTA signs of choroidal melanoma (CM) depending on its sizes. MATERIAL AND METHODS: The study included 24 patients with CM (24 eyes, of them with small CM - 22 eyes) aged 55.0±12.08 years (37 to 80 years old) with mean prominence of 2.35±0.87 mm (1.0 to 4.7 mm). RESULTS AND DISCUSSION: Retinal vascular attenuation in the tumor area was observed in 21 eyes. Changes in angioarchitectonics in the area of CM localization can be detected at a thickness of 1 mm, and the tumor's own vasculature - starting with a thickness of 1.4 mm. The development of vascular changes in CM can be represented as follows: initially, with CM prominence of up to 1.4 mm, indirect signs of increased blood flow in the overlaying choriocapillaris layer are visualized, most likely due to its compression; as the tumor grows and its thickness increases in its most dominant part, the choriocapillaris layer is completely destroyed, which leads to reactive expansion of the choroidal capillaries along the layer's edges. This is manifested as attenuation of the vascular signal in the central part of the tumor and its intensification along its edges. In the meantime, collaterals begin to form in the deep vascular plexus of the retina. Later on, chaotic vascular arches begin to form in the inner layers of the choroid along the tumor edge; as the tumor grows, they anastomose with the retinal vessels. Identification of the tumor's own vessels in the deeper-lying layers is possible with tumor prominence of at least 1.4 mm. At the level of the deep choroidal layers, the tumor's vascular pattern is more consistent with the angiographic data and patterns of vasculogenic mimicry described in literature. CONCLUSION: Changes in angioarchitectonics in the area of CM localization can be detected at a thickness of 1 mm, and the tumor's own vasculature - starting with a thickness of 1.4 mm. The vascular pattern at the level of the deep choroidal layers best corresponds to the reported angiographic picture and patterns of vasculogenic mimicry.
Assuntos
Neoplasias da Coroide , Melanoma , Adulto , Idoso , Corioide/diagnóstico por imagem , Neoplasias da Coroide/diagnóstico por imagem , Angiofluoresceinografia , Humanos , Melanoma/diagnóstico por imagem , Pessoa de Meia-Idade , Vasos Retinianos , Tomografia de Coerência ÓpticaRESUMO
Achieving local tumor control is generally considered to be the criterion of effectiveness of organ preservation treatment. In most cases it can be assessed by ophthalmoscopy and ultrasonography. However, in presence of pigmentation areas, it can be difficult to interpret the ophthalmoscopy and ultrasonography findings. The works concerning the informativity of optical coherence tomography (OCT) after organ preservation treatment of choroidal melanomas (CM) generally cover the complications (post-radiation maculopathy, neuropathy) and the identification of vitreomacular tractions. In evaluation of local control, attention is paid to the presence of subretinal fluid and/or retinal pigment epithelium (RPE) detachment. PURPOSE: To analyze OCT findings in terms of the condition of eye fundus tissues in various outcomes of organ preservation treatment of CM. MATERIAL AND METHODS: The study included 20 patients (20 eyes) who underwent the following organ preservation therapy 1 to 374 months prior to enrollment: transpupillary thermotherapy (TTT) - 8 eyes, brachytherapy (BT) - 8 eyes, BT with subsequent TTT - 4 eyes. Mean age of patients at the time of therapy start was 59.25±10.86 (33-81) years. In multi-step therapy (12 eyes), the mean interval between the stages was 28.08±20.39 months. According to echobiometry findings, tumor prominence at the time of therapy start was 3.35±2.08 (1-7.37) mm. At the time of post-treatment OCT scan, there was no prominence in 5 eyes, in other eyes it was 1.26±1.24 (0.4-5.7) mm. RESULTS: Comparison of ophthalmoscopy picture with OCT findings allowed identification of the following changes: a scar and hyperplasia of pigment epithelium in the scar, a scar with reactive pigment hyperplasia at the level of RPE and choroid, radioreaction, growth area from under and inside the scar, incomplete local control, absence of local control. CONCLUSION: The author's own expertise in evaluating the effectiveness of local choroidal melanoma therapy suggests that optical coherence tomography should be used to monitor all patients being followed up after organ preservation treatment of choroidal melanoma: after transpupillary thermotherapy - for 3 months, after brachytherapy - during first 24 months, and in case of doubts for longer.
Assuntos
Neoplasias da Coroide , Melanoma , Idoso , Corioide/diagnóstico por imagem , Neoplasias da Coroide/diagnóstico , Neoplasias da Coroide/terapia , Angiofluoresceinografia , Humanos , Melanoma/diagnóstico por imagem , Melanoma/terapia , Pessoa de Meia-Idade , Preservação de Órgãos , Tomografia de Coerência ÓpticaRESUMO
The risk of choroidal melanoma developing from choroidal nevus (CN) varies in range of 0.78-7%. Absence of a common terminology and distinct diagnostic criteria characterizing small melanoma de novo and unusual CN often complicates treatment choice and patient prognosis. PURPOSE: To study the clinical features and the role of visualization methods in the diagnosis of CN transformation into melanoma. MATERIAL AND METHODS: The study analyzes the clinical picture and visualization results of 11 patients with initial diagnosis of «choroidal nevus¼ (n=3) and «suspicious choroidal nevus¼ (n=8). RESULTS AND DISCUSSION: Examination and continued observation revealed 7 patients to have melanoma that had developed from CN (2 of them confirmed with histological studies). The time before CN transformed into melanoma varied between 4 and 13 years, with median 5 [4; 12] years. Two patients were diagnosed with primary melanoma (melanoma de novo), two other patients - with suspicious CN. In progressive CN transforming into melanoma, visual impairments occurred between 6 months and 13 years in 6 out of 7 patients. Initial prominence of suspicious CN at the first visit was 1.9±0.68 mm (0.9 mm to 2.67 mm). The characteristic features of suspicious CN transforming into initial melanoma are: 1) asymmetric shape of the edges of expanded choroidal complex; 2) presence of areas of damaged choriocapillaris layer, direct and indirect signs of loss of integrity of the Bruch's membrane; 3) areas of accumulation of moderately hyperreflective subretinal exudate; 4) presence of intraretinal hyperreflective inclusions. The signs distinguishing primary choroidal melanoma from melanoma that had developed from CN are: 1) absence of areas with tomography pattern characteristic of nevi; 2) more pronounced asymmetry of the shape of edges, compared to melanoma developed from CN; 3) presence of cysts in larger tumors, compared to melanoma developed from CN. CONCLUSION: All patients with CN should be regularly followed up by an ophthalmologist.
Assuntos
Neoplasias da Coroide , Melanoma , Nevo , Neoplasias Cutâneas , Neoplasias da Coroide/diagnóstico , Humanos , Melanoma/diagnóstico , Tomografia de Coerência ÓpticaRESUMO
The article provides a detailed review of the ophthalmoscopic picture, optical coherence tomography (OCT) of the retina and fundus autofluorescence in patients with such rare pathological processes in the fundus as torpedo maculopathy, retinal myelin fibers, retinal astrocytic hamartoma and cavernous hematoma.
Assuntos
Hamartoma , Doenças Retinianas , Angiofluoresceinografia , Humanos , Retina , Tomografia de Coerência ÓpticaRESUMO
The article describes a difficult case of differential diagnosis of local choroiditis developed after influenza (flu) vaccination in a patient with bronchial asthma who receives systemic steroid therapy.
Assuntos
Corioidite , Influenza Humana , Angiofluoresceinografia , Humanos , Vacinação , Acuidade VisualRESUMO
Differential diagnostics of age-related macular degeneration and choroidal tumor is a challenging task for ophthalmologists. Difficulties arise on various stages during establishing the diagnosis: when interpreting ophthalmoscopic picture, or when evaluating the results of visualization methods. The article describes a clinical case of differential diagnostics of age-related macular degeneration and choroidal tumor. The difficulties emerged when interpreting results of ultrasound examination. Optical coherence tomography helped exclude choroidal tumor.
Assuntos
Neoplasias da Coroide , Neovascularização de Coroide , Degeneração Macular , Corioide , Diagnóstico Diferencial , Angiofluoresceinografia , Humanos , Tomografia de Coerência ÓpticaRESUMO
Encephalotrigeminal angiomatosis (Sturge-Weber syndrome) is a congenital sporadic disease characterized by angiomatosis of meningeal vessels, facial and eye capillaries. The article presents a clinical case of comorbidity between monolateral skin angioma, ipsilateral conjunctival and choroidal angiomas without intraocular pressure elevation. The case is unusual due to asynchronous manifestation of the clinical signs of Sturge-Weber syndrome. Facial angioma was diagnosed at birth, while conjunctival angioma appeared at the age of 45 - at the same time as monolateral hypermetropia, which may be the first symptom of diffuse choroidal angioma.
Assuntos
Neoplasias da Coroide , Hemangioma , Neoplasias Cutâneas , Síndrome de Sturge-Weber , Angiomatose , HumanosRESUMO
The article reviews literature on various methods of optical coherence tomography (OCT). The review also describes clinical aspects of OCT angiography and its applications in ophthalmic oncology.
Assuntos
Corioide , Tomografia de Coerência Óptica , Angiofluoresceinografia , Fundo de OlhoRESUMO
Literary sources suggest the existence of a new phenotype - retinoinvasive choroidal melanoma (CM). However, the factual evidence of its spreading over the inner retinal surface cannot be dismissed. PURPOSE: To study the capabilities of optical coherence tomography (OCT) in terms of finding the ways CM spreads into the retina based on pathomorphological examination of the eyes enucleated due to CM. MATERIAL AND METHODS: OCT tomograms of 64 eyes with CM (mean tumor elevation - 2.89±0.19 mm, diameter - 9.58±0.43 mm) were studied. Pathomorphological study was conducted on 18 eyes with CM elevated by up to 7 mm and without previous treatment. RESULTS: OCT revealed signs of melanoma invading into the retina in 49 eyes. Among those signs were: presence of retina/CM aggregation (21 eyes), tearing of Bruch's membrane and retinal pigment epithelium, disturbed differentiation of outer retinal layers (15 eyes). Combination of two types of invasion was found in 11 eyes. Pathomorphological study showed low mitotic activity of CM and the presence of a small number of fine-local necroses and hemorrhages. Invasion of CM into the retina was determined in 13 eyes. Retinal invasion began with local destruction of Bruch's membrane (BM) and was often limited by the photoreceptor level, disturbing architectonics of the retina and nuclear layers. Large CMs were accompanied by rough destruction of the Bruch's membrane, tumor cells - in the edematous retina with cystoid dystrophy, in its inner layers, invading into the vitreous body. Infiltration of the retina to inner nuclear layer was accompanied by its transudative detachment and cystoid dystrophy. CONCLUSION: Invasion of CM into the retina affecting all of its layers imposes use of OCT to examine the integrity of the retina, even with a tumor of small thickness. Tumoral infiltration of the retina and localization of tumor near the optic disc are two contraindications for local endovitreal resection. Brachytherapy requires consideration of tumor characteristics and thickness of the retina for calculation of apical radiation dose.
Assuntos
Neoplasias da Coroide , Melanoma , Humanos , Retina , Epitélio Pigmentado da Retina , Tomografia de Coerência ÓpticaRESUMO
When planning conservation therapy for choroidal melanoma (CM), evaluation of its size and stage is done using various methods of visualization, among which is optical coherence tomography (OCT). A recently introduced modification of OCT - Enhanced Depth Imaging (EDI) allows observation of deep choroid and sclera. PURPOSE: To specify clinicomorphologic correlations between OCT signs related to CM and its pathomorphological state as described in literature. MATERIAL AND METHODS: The study included 33 patients with predominantly small CM who were examined with EDI-OCT. RESULTS: The following surface profiles were revealed: small and medium sized CM with even and uneven surface and with a plateau on the top; medium sized CM with flattened edge. Bruch's membrane (BM) had folds along the tumor edge in medium and big CM. In mushroom-shaped CM, extended defective areas could be observed. Increase of optical density in the inner parts of choroidal complex were seen over time. In CM of 2.9 mm and less, cavities were observed in the middle layers of choroid in the tumor area. In roughly half of the cases, vascular distention was seen in choroid in the tumor periphery. Changes of retinal pigment epithelium (RPE) included its thickening and presence of hyperreflective foci. In CM with prominence of more than 2.17 mm at the top, the changes included the formation of a 'single unitary block' at the level of BM/RPE and neurosensory retinal layers. Intraretinal cysts could be seen on top of the tumor at the level of outer retinal layers in CM with prominence of more than 1.5 mm. CONCLUSION: Comparison of OCT images of CM with various biometric parameters with literature data on pathomorphological changes helped specify early pathomorphological symptoms in perifocal choroid (a feature of initial CM) and highly dynamic phasing of secondary changes in the retina.
Assuntos
Melanoma , Tomografia de Coerência Óptica , Corioide , Humanos , Melanoma/diagnóstico por imagem , MorfogêneseRESUMO
The article presents two clinical cases of sclerochoroidal calcification. This is a rare benign condition that usually does not display itself and is only occasionally diagnosed. It can also be accompanied by systemic disorder of mineral metabolism. The data obtained through medical imaging indicate partial destruction of the choroid at the site of the damage that causes secondary changes in the overlying retina.
Assuntos
Calcinose/diagnóstico por imagem , Doenças da Coroide/diagnóstico , Corioide , Retina , Esclera , Doenças da Esclera/diagnóstico , Corioide/diagnóstico por imagem , Corioide/patologia , Doenças da Coroide/complicações , Diagnóstico Diferencial , Feminino , Angiofluoresceinografia/métodos , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Oftalmoscopia/métodos , Retina/diagnóstico por imagem , Retina/patologia , Esclera/diagnóstico por imagem , Esclera/patologia , Doenças da Esclera/complicações , Tomografia de Coerência Óptica/métodos , Ultrassonografia/métodosRESUMO
The article presents a clinical case of torpedo maculopathy. This congenital disorder is most likely to be caused by changes in the retinal pigment epithelium (RPE) during retinal fissure closure. Visual function is usually unaffected and the condition is revealed at routine ophthalmic examination in children and teens. Optical coherence tomography showed the absence of RPE, photoreceptor damage, and massive thinning of the outer nuclear layer at the diseased site without a significant change in the total retinal thickness. RPE involvement was also evidenced by changes in fundus autofluorescence.
Assuntos
Macula Lutea , Doenças Retinianas , Criança , Diagnóstico Diferencial , Feminino , Angiofluoresceinografia/métodos , Fundo de Olho , Humanos , Achados Incidentais , Macula Lutea/anormalidades , Macula Lutea/diagnóstico por imagem , Doenças Retinianas/congênito , Doenças Retinianas/diagnóstico , Epitélio Pigmentado da Retina/anormalidades , Tomografia de Coerência Óptica/métodos , Acuidade VisualRESUMO
Intraocular metastases account for 64-67% of all metastatic ocular tumors, of them 88-90.7% are found in the choroid. By the time the metastasis is diagnosed, 30-44% of patients usually have their primary lesion identified. In oncology patients with multiple and/or bilateral choroidal involvement, the diagnosis can be easily determined at ophthalmoscopy, while in those whose anamnesis is unburdened, this task is quite challenging. Aim - to define diagnostic criteria of choroidal metastases that would consider data provided by state-of-the-art instrumental assessment. MATERIAL AND METHODS: The study enrolled 5 patients (3 women and 2 men) with choroidal metastases of different origin. The mean patient age at the time of ocular involvement was 47.8 years (38-60 years). Oncological anamnesis was burdened in only 2 cases. RESULTS: Due to the small number of cases and diverse clinical presentation, we considered appropriate to describe each case separately. CONCLUSION: The absence of a known pre-existing lesion is typical of the younger age group. By analyzing optical coherence tomography data, we are able to list the most common signs of all choroidal metastases: hummocky profile of the choroid and a high neuroepithelium detachment accompanied by edema and photoreceptor damage. Fluorescein angiography diagnostic criteria are the following: spotted hyperfluorescence that begins in the arterial phase and gradually increases in intensity, while choroidal fluorescence is blocked during the whole examination; almost confluent hyperfluorescence with brighter pin-points along the margin of the lesion seen in the later phases. Evaluation of autofluorescence is auxiliary, but can provide an idea of the disease duration.
Assuntos
Neoplasias da Mama/patologia , Neoplasias da Coroide , Corioide , Neoplasias do Colo/patologia , Adulto , Corioide/diagnóstico por imagem , Corioide/patologia , Neoplasias da Coroide/diagnóstico , Neoplasias da Coroide/patologia , Neoplasias da Coroide/fisiopatologia , Neoplasias da Coroide/secundário , Diagnóstico Diferencial , Feminino , Angiofluoresceinografia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Oftalmoscopia/métodos , Tomografia de Coerência Óptica/métodosRESUMO
AIM: To investigate the sequence of OCT manifestations in choroidal melanoma (CM) with account to its growth. MATERIAL AND METHODS: A total of 28 CM patients were examined. Of them, 18 patients with early CM, 10 - with medium-sized CM. The mean patient age at diagnosis was 60.54±5.31 years. Tumor location was macular (15 eyes) or perimacular (13 eyes), its prominence varied from 0.98 to 4.9 mm and basal diameter - from 5.08 to 18.9 mm. Additionally to OCT, tumor autofluorescence was studied in all cases. RESULTS: The sequence of OCT manifestations in CM has been investigated with account to its growth. Our findings include an early change in choroidal profile with often uneven configuration and a plateau in the most prominent part of the lesion. Along with changes in the retinal pigment epithelium (RPE), one could see signs of an initially local small neuroepithelial detachment (NED) with alterations in the photoreceptor layer. We have identified three types of photoreceptor damage. Destruction of all retinal layers (its morphofunctional disorder) indicates the transition of an early CM to a medium one. As to autofluorescence RESULTS: there were lipofuscin deposits in RPE cells detected in OCT scans that showed an evident hyperautofluorescence. The central part the tumor was notable for its hypoautofluorescence. The periphery of the lesion was hyperautofluorescent due to NED. CONCLUSION: Qualitative changes in the retina overlying choroidal melanoma develop early in the course of the disease, practically in the moment of the first shift of choroidal profile. Destruction begins with the RPE and neuroepithelium (detachment and structural changes). As the tumor grows, retinal architectonics gets irreversibly distorted: the tissue becomes thicker due to edema, cysts, and intraretinal deposits. This process is, of course, accompanied by changes in metric parameters of all retinal layers and the choroid within the area of interest.