Sclerochoroidal Calcifications: Wide-Field Imaging

Purpose: To report the clinical and angiographic appearance of sclerochoroidal calcifications utilizing Optos wide-field fundus imaging. Methods: Case Report Results: An 80 year-old white female presented with blurred vision in her right eye. On examination she was found to have arc-shaped lesions that were superior to the macula in each eye. Diagnostic studies included ultrasonography, optical coherence tomography (OCT), and wide-field fundus imaging with fluorescein angiography. These studies confirmed the diagnosis of sclerochoroidal calcifications. Metabolic studies were performed, as these may be a manifestation of abnormal calcium metabolism. Conclusion: Sclerochoroidal calcifications are an unusual fundus lesion, and we have found Optos wide-field fundus imaging to be an important asset in the diagnosis of this rare entitiy.     

Optos Panoramic200A fluorescein angiography for proliferative diabetic retinopathy with asteroid hyalosis

We report a unique situation in which the use of Optos Panoramic200A fluorescein angiography directed the management of a patient with asteroid hyalosis and active proliferative diabetic retinopathy. The Optos Panoramic200A system provides a 200 degrees field of view, which may be useful in selected cases where simultaneous view of the posterior pole and periphery is important. The Optos fluorescein angiogram directed the management of our patient with proliferative diabetic retinopathy combined with asteroid hyalosis.     

脉络膜黑色素瘤的三种影像学检查对比分析

目的通过对比超声、磁共振成像及眼底血管造影三种影像学检查方法对脉络膜黑色素瘤的诊断结果与病理诊断的一致性，探讨脉络膜黑色素瘤影像学检查的合理应用方法，提高脉络膜黑色素瘤的确诊率。设计回顾性病例系列。研究对象疑诊为脉络膜黑色素瘤的26例（28眼）患者。方法对26例（28眼）疑诊为脉络膜黑色素瘤患者术前进行眼B超和（或）彩色超声多普勒血流成像（CDFI）、磁共振成像（MRI）、荧光素眼底血管造影（FFA）和（或）吲哚青绿血管造影（ICGA）检查，结合病理诊断，应用SPSS12．0软件对影像学检查结果与病理诊断的一致性进行统计学分析。主要指标眼部超声、MRI、眼底血管造影的表现及肿瘤病理诊断。结果三种影像学检查结果与病理诊断的一致性由好到差依次为：MRI（r=0．494，P=0．010）、超声检查（k=0．348，P=0．050）、眼底血管造影（k=0．140，P=0．463）；超声检查对脉络膜黑色素瘤诊断的敏感度和特异度分别为95．2％和33．3％，MRI的敏感度和特异度分别为85．7％和66．7％，眼底血管造影的敏感度和特异度分别为76．2％和40．0％。联合MRI和眼底血管造影或三种影像学检查的诊断结果与病理诊断的一致性最好（k=0．886，P=0．000），其对脉络膜黑色素瘤诊断的敏感度和特异度分别为100％和83．3％。结论三种影像学检查联合是目前除病理外敏感性和特异性最佳的诊断方法，优于单独应用以及其他两两组合。     

Viewing Through the Asteroids

Thirty to seventy percent of patients with asteroid hyalosis will also have diabetes. In this group of patients where view of the fundus is essential, it is often difficult or impossible by conventional ophthalmoscopy. We have noted the excellent visualization of fundus detail in asteroid hyalosis on routine fundus fluorescein angiography. The asteroid bodies are “optically removed” from the vitreous with this technique, thus affording a view for diagnosis previously thought impossible without actual vitrectomy. A series of patients, optimal camera filter combination, and a theory for this effect are presented.     

眼底荧光造影、眼科B超对脉络膜黑色素瘤的诊断应用

目的:探讨荧光素眼底血管造影(fundus fluorescein angiog-raphy,FFA),眼科B超的影像学特征对脉络膜黑色素瘤的诊断帮助。方法:2005/2008年取FFA、眼B超诊断为脉络膜黑色素瘤的患者11例,并对脉络膜黑色素瘤疾病的不同检查影像结果进行对比分析。结果:FFA肿瘤早期无荧光显影,晚期荧光增多,呈现斑驳样高低荧光混杂的斑驳形态;B超:多自球壁凸向玻璃体腔的实性肿物,多呈蘑菇形、圆顶形的均质结构,肿瘤内可见挖空现象及脉络膜凹陷。结论:在临床中,FFA和眼科B超检查应相互结合,相互补充,FFA和B超检查可清晰显示病变部位及发展过程,可用于指导临床治疗。     

Clinical Course of a Presumed Metastatic Uveal Melanoma to the Contralateral Choroid

Abstract

We present the ultrasound and optic coherence tomography follow-up of a presumed choroidal metastasis from a contralateral melanoma. A 53-year-old male was diagnosed with uveal melanoma with extraescleral extension in his left eye. A year later, the fundus examination revealed a flat, gray-green, pigmented choroidal lesion in the right eye. The ultrasonography showed a mass, almost flat, and all these findings were compatible with a choroidal melanocytic lesion with risk factors for growth. One month later, melanocytic skin lesions appeared on the scalp, as well as small tumors. Three months later, an ultrasonography on B scan showed a growth of the tumor size. The patient developed a progressive deterioration and died. Three possibilities can explain the occurrence of a choroidal pigmented tumor in the contralateral eye: first, bilateral primary choroidal melanomas; second, both choroidal tumors are metastatic in origin from an unknown primary melanoma; and third, the contralateral tumor is a metastatic tumor from the primary choroidal melanoma.     

Digital imaging in differential diagnosis of small choroidal melanoma

Background To assess the role of digital imaging and a new subtraction method for differential diagnosis of choroidal nevus and small choroidal melanoma.Methods Of 241 consecutive patients referred to a tertiary referral center for suspected choroidal melanoma, 110 who underwent digital imaging of the ocular fundus were eligible for this study. Digital color, red-free and red light retinal images were evaluated in a randomized and masked manner and by the subtraction method for diagnosis of the fundus lesion. The reference standard was based on the combined results of ophthalmological examination, including mydriatic ophthalmoscopy, B scan ultrasonography, digital imaging and fluorescein angiography of the ocular fundus.Results Comparative use of digital color, red-free and red light imaging had 85.7% (95%CI 42.1–99.6) sensitivity, 99.0% (95%CI 94.7–99.9) specificity and 98.2% (95%CI 93.6–99.8) exact agreement versus reference standard in differentiation of small choroidal melanoma from pseudomelanoma. Direct comparison between use of digital images and the reference standard showed excellent agreement in detecting small choroidal melanoma from suspected choroidal lesions (κ 0.847; 95%CI 0.639–1.0). The subtraction method was useful to show growth in four of 94 melanocytic choroidal tumors. The mean annual incidence of choroidal melanoma in Southwest Finland was 0.80 per 100.000 population. The most frequent choroidal pseudomelanomas were choroidal melanotic and amelanotic nevi, disciform lesions, congenital hypertrophy of the retinal pigment epithelium, and circumscribed choroidal hemangioma.Conclusions Combined use of digital color, red-free and red light imaging was a suitable adjunct in differentiation of small choroidal melanoma from different pseudomelanomas. The subtraction method may reveal early growth of the melanotic choroidal tumors.This study was supported by grants from the Turku University Central Hospital (grant no. 13498), Turku, and the Finnish Medical Foundation, Helsinki, Finland     

False positive magnetic resonance imaging of a choroidal nevus simulating choroidal melanoma

A 68-year-old white male had a pigmented choroidal tumor associated with progressive loss of vision. Clinical studies with fluorescein angiography and magnetic resonance imaging suggested a diagnosis of choroidal melanoma. Specimens obtained by internal eye wall resection revealed a choroidal nevus.     

Manifestations of fluorescein angiography in choroidal melanoma

This paper reported on the manifestations of fundus fluorescein angiography in 21 patients with choroidal melanoma. According to the findings of fluorescein angiography, we suggest that this disease can be classified into 3 types: type I shows hyperfluorescent mottles (12 cases); type II shows hyperfluorescent spots and patches, (4 cases); type III shows a dark area in the tumor body, (5 cases). The angiographic characteristics of the three types of melanoma and their histopathologic changes are discussed. The differential diagnosis of the three types of melanoma from metastatic choroidal carcinoma, senile macular degeneration with subretinal hemorrhage and choroidal hemangiomas is discussed. For the first time choroid melanoma has been classified into 3 types according to fluorescein angiography. It may contribute to the early diagnosis of this disease.     

Optical coherence tomography to detect macular edema in the presence of asteroid hyalosis

PURPOSE: To propose the use of optical coherence tomography as an effective diagnostic tool for identifying macular edema in patients with asteroid hyalosis obscuring the fundus view. DESIGN: Case report. METHODS: Review of clinical chart and images. SETTING: Private retina practice. PATIENT: One patient diagnosed with diabetic retinopathy and asteroid hyalosis, who was experiencing decreased visual acuity and whose fundus view was inadequate for diagnosis using customary techniques. RESULTS: Usual methods of diagnosis were ineffective until OCT obtained a clear image of the fundus and subsequent macular thickening with vitreomacular adhesion. CONCLUSIONS: Optical coherence tomography is an effective diagnostic tool for discovering macular edema in cases of dense asteroid hyalosis where traditional methods fail to obtain a clear image of the fundus.     

Ultra-wide field angiography in the management of Eales disease

Aims:This study aims to evaluate the use of ultra-wide field (UWF) angiography in patients with Eales disease (ED).Results:24 eyes of 17 patients with mean age of 26.3 years were diagnosed with ED and underwent UWF angiography. UWF fluorescein angiography was helpful in the documentation of peripheral retinal changes (in 67% of eyes), exact localization of capillary nonperfusion (CNP) (in 54% of eyes), and in determination of vascular involvement (in 21% of eyes). In 33% of eyes, immediate treatment plan changed because of changes picked up on UWF angiography.Conclusions:UWF angiography helped in the better documentation, exact quantification, and location of CNP areas and better determination of disease activity. UWF imaging may play an important part in the management of patients with ED.Key words: Eales disease, fluorescein angiography, ultra-wide field imagingEales disease (ED) is a vaso-proliferative disorder of the retina characterized by peripheral retinal ischemia, neovascularization (NV) and recurrent vitreous hemorrhages.[1] This is a result of inflammation of small peripheral retinal veins. ED is a diagnosis of exclusion and is particularly common in the Indian subcontinent with an estimated incidence of 1 in 200–250 ophthalmic patients.[2] The treatment involves administration of peribulbar or systemic steroids in the stage of inflammation.[3] One of the crucial steps of management in ED, once NV occurs, is to ablate the peripheral ischemic areas with laser photocoagulation so as to avoid complications such as recurrent vitreous hemorrhages and tractional retinal detachment.[4] Fundus fluorescein angiography (FFA) plays a crucial role in detecting NV.The conventional fundus cameras image 30–60° of the retina.[5] The montage images can increase the amount of retinal area imaged.[6] This may, however, result in significant time and manpower consumption and maybe a source of discomfort to the patient. Often it is impossible to image and document the anterior retinal changes occurring in ED.Optos Tx200[7] (Optos PLC, Dunfermline, Scotland, UK) is a confocal scanning laser ophthalmoscopy (cSLO) based technology, which images up to 200° of the retina and can capture color, fluorescein angiography, indocyanine green angiography, and autofluorescence images. The purpose of this study was to evaluate Optos ultra-wide field (UWF) angiography in the diagnosis and treatment of ED.     

脉络膜黑色素瘤临床病理分析

本文总结了我院１９８５年至１９９１年经病理证实的４０例脉络膜黑色素瘤。分析其临床、超声波、眼底荧光血管造影的特点及病理改变。并对荧光血管造影的病理机制进行初步探讨。眼底荧光血管造影中于肿瘤内的低荧由肿瘤细胞及其内色素、坏死、血窦等所致。而高荧主要由肿瘤内血管和其上脱落的变性的色素上皮细胞所致。     

脉络膜转移癌的荧光素和吲哚菁绿血管造影的影像分析

目的：比较脉络膜转移癌的荧光素眼底血管造影(FFA)及吲哚菁绿血管造影(ICGA)的影像特点,为该疾病的准确诊断提供依据。

方法：经临床诊断,有明确原发恶性肿瘤病灶的患者6例8眼,散瞳后行眼底照相,用海德堡眼底血管造影仪行FFA及ICGA同步造影,比较两种影像学检查的异同。

结果：FFA早期显示瘤体为低荧光,中期呈现针尖样或斑点样荧光,晚期表现为斑驳样强荧光,部分病例病灶边缘呈强荧光环带; ICGA显示的病灶表现为低荧光,整个造影过程中荧光强弱无明显变化,仅有1例病例在反转期出现中央及病灶周围的点状强荧光。

结论：FFA和ICGA对于脉络膜转移癌有较为特征性的表现,二者结合有助于脉络膜转移癌的诊断。     

Cavitary choroidal melanoma

CASE REPORT: We report an unusual case of cavitary choroidal melanoma. The results of ultrasonography, magnetic resonance imaging, computed tomography, and immunohistochemical studies are presented for a 38-year-old woman who developed an amelanotic tumor in the posterior choroid. B-scan ultrasonography disclosed intratumoral cavitations. Systemic and extraocular extension studies were negative. Enucleation was performed and histopathologic examination showed a choroidal melanoma of spindle cell type, with intratumoral cavitations lined by flattened tumor cells.COMMENTS: The majority of previous reports of intraocular cavitary tumors describe cavitary ciliary body tumors. Uveal melanoma should be included in the differential diagnosis of choroidal cavitary lesions. As far as we know, this is the second documented clinicopathologic correlation of a cavitary choroidal melanoma.     

Digital Infrared Fundus Reflectance

An infrared sensor was inserted at the film plane of a fundus camera. The signal was visualized on an oscilloscope. In this manner we measured infrared reflectance from the surface of the fundus. The purpose was to characterize choroidal malignant melanomas more reliably than is done with infrared color translation photography. Control lesions were choroidal nevi, metastatic tumors, and disciform macular degenerations. Correlations were made with radioactive phosphorus (³²P) uptake, fluorescein angiography, and histopathologic findings. Several cases are presented, one in which this new method of infrared detection was the first diagnostic test to detect the spread of a choroidal melanoma. The simplicity of this technique and its increased accuracy justify the needed further refinements.     

Giant nodular posterior scleritis compatible with ocular sarcoidosis simulating choroidal melanoma

CASE REPORT: A 30-year-old man was referred to our ocular oncology service with a diagnosis of amelanotic choroidal melanoma of the left eye. The following tests were performed: ophthalmoscopy, fluorescein angiography, indocyanine green angiography, ultrasonography, magnetic resonance imaging and biopsy. DISCUSSION: The diagnosis of giant nodular posterior scleritis, as suggested by ultrasonography, was confirmed by biopsy. A comprehensive medical evaluation was performed, but no etiology was found. The histology revealed a granuloma compatible with ocular sarcoidosis. A rapid response was obtained by systemic steroid administration (1 mg/kg). Sarcoidosis continues to be a challenge in diagnosis. It is important to distinguish nodular posterior scleritis from choroidal melanoma.     

Autofluorescence of orange pigment overlying small choroidal melanoma

PURPOSE: To describe the autofluorescence features of orange pigment (intracellular lipofuscin) overlying small presumed choroidal melanomas. METHODS: The diagnostic testing results (fluorescein angiography, optical coherence tomography, and fundus autofluorescence imaging) for two patients with pigmented choroidal melanoma and two patients with nonpigmented choroidal melanoma were reviewed. RESULTS: Clinically, the intracellular lipofuscin pigment appeared brown overlying the nonpigmented melanoma (two cases) and orange overlying the pigmented melanoma (two cases). Fluorescein angiography demonstrated that the lipofuscin pigment displayed fluorescein blockage in all four cases. Optical coherence tomography revealed serous retinal detachment in all four cases. Fundus autofluorescence imaging showed discrete, bright hyperautofluorescence of the orange pigment separated by hypoautofluorescent voids. The melanoma was isoautofluorescent. CONCLUSIONS: Intracellular lipofuscin overlying small choroidal melanomas shows discrete and bright hyperautofluorescence. The brightness correlates directly with the clinically visible orange pigment.     

Ultra-wide-field fluorescein angiography of the ocular fundus

PURPOSE: To evaluate the clinical applicability of a novel scanning laser ophthalmoscopy imaging system for ultra-wide-field fluorescein angiography. DESIGN: Observational case report. METHODS: Wide-field fluorescein angiography images were captured in normal volunteers and in patients with a variety of clinical disorders with a newly developed scanning laser ophthalmoscope (Optomap; Optos PLC., Dunfermline, Scotland, United Kingdom) that produces high-resolution images of the fundus up to a 200-degree field. Fluorescein angiograms were performed using standard sequence times. RESULTS: Peripheral vascular perfusion of all four quadrants of a normal fundus was observed with good detail of the capillary architecture. Patients with diabetes and ocular inflammatory eye disease showed evidence of peripheral retinal nonperfusion. The relative degrees of retinal perfusion and nonperfusion could be compared in single images. CONCLUSIONS: Ultra-wide-field fundus fluorescein angiography offers the possibility of evaluating and quantitating peripheral retinal perfusion and vascular pathology in fundus disease.     

广角激光扫描血管造影技术在脉络膜黑色素瘤诊断中的应用价值

目的 评价广角激光扫描血管造影技术在脉络膜黑色素瘤诊断中的应用价值。 方法 将24例临床诊断为脉络膜黑色素瘤的患者随机分为两组，分别应用激光扫描检眼镜的广角接触镜系统和非接触镜成像镜头对其行荧光素眼底血管造影和吲哚青绿血管造影的全景造影扫描，获得150°广角视野图像和30°视野图像资料，并对其成像质量进行综合评定。 结果 24例患者均获得满意的影像资料。广角成像系统提供了病变位置与其他解剖结构准确的毗邻关系，提供了病变的大小和造影过程中瘤体血管充盈情况的全面信息。同时将传统造影视野范围提高了3～5倍，有助于周边病变的筛查。 结论 广角激光扫描血管造影技术在脉络膜黑色素瘤诊断中有重要的应用价值。 (中华眼底病杂志, 2006, 22: 166-169)     

CLINICAL APPRAISAL AND RETINAL IMAGING IN POSTERIOR MICROPHTHALMOS

Purpose: To report a critical case series of five patients with posterior microphthalmos and the review of their clinical findings with the analyses of retinal imaging. Method: Case series. Complete ophthalmological examinations including optical coherence tomography (OCT) were evaluated. Results: All patients had decreased visual acuity with high hyperopic refraction. Dilated fundus examination demonstrated that elevated papillomacular retinal folds with anterior segment were unremarkable. Total axial lengths measurements showed reduced axial lengths and B-scan ultrasonography revealed sclerochoroidal thickening. Moreover, papillomacular folds were confirmed by OCT. Conclusion: Dilated fundus examination, fundus fluorescein angiography, orbital ultrasonography, and proper OCT evaluation will be helpful to reach a diagnosis.