Choroidal naevi complicated by choroidal neovascular membrane and outer retinal tubulation

Papastefanou, Vasilios P.; Nogueira, Vanda; Hay, Gordon; Andrews, Richard M.; Harris, M. L.; Cohen, Victoria M L; Sagoo, Mandeep S.

doi:10.1136/bjophthalmol-2013-303234

Cited by 33 publications

(15 citation statements)

References 15 publications

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“…The largest case series has been reported by Papastefanou et al ,7 demonstrating an association between the choroidal naevus and different types of CNV in 17 patients. However, in this series only the distinction between classic and occult CNV has been made, without mention of polypoidal lesions and choroidal features.…”

Section: Discussionmentioning

confidence: 96%

Polypoidal lesions associated to choroidal naevus: spectrum of pachychoroid disease?

Anzidei¹,

Mata

Deane

2018

BMJ Case Reports

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A 78-year-old woman was referred by an optician for an incidental finding of peripapillary naevus in the absence of visual symptoms. On examination, the right eye showed a choroidal naevus of around 1.5 disc diameter, adjacent to the optic disc. Optical coherence tomography detected the presence of pigment epithelium detachment and subretinal fluid within the context of the naevus. Fundus fluorescein angiography and indocyanine green showed multiple polypoidal lesions (Polypoidal Choroidal Vasculopathy, PCV) in the choroid within the spectrum of a pachychoroid, without any sign of malignancy related to neovascularisation. The patient underwent a follow-up of 6 months, showing stability of the lesions over this timeframe. No treatment has been required since the polypoidal lesions were outside the fovea and visual acuity remained stable. The association between choroidal naevi and polypoidal lesions is rare; however, this seems to confirm that these findings are part of the spectrum of pachychoroid disease.

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Section: Discussionmentioning

confidence: 96%

Polypoidal lesions associated to choroidal naevus: spectrum of pachychoroid disease?

Anzidei¹,

Mata

Deane

2018

BMJ Case Reports

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“…Proper recognition of ORT is important clinically, for discriminating its presence from ongoing neovascular activity. 5, 6, 11 …”

Section: Introductionmentioning

confidence: 99%

Outer Retinal Tubulation in Advanced Age-Related Macular Degeneration

Schaal

Freund

Litts

et al. 2015

Retina

116

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Purpose To compare optical coherence tomography (OCT) and histology of outer retinal tubulation (ORT) secondary to advanced age-related macular degeneration (AMD) in patients and in post-mortem specimens, with particular attention to the basis of the hyper-reflective border of ORT. Method A private referral practice (imaging) and an academic research laboratory (histology) collaborated on two retrospective case series. High-resolution OCT raster scans of 43 eyes (34 patients) manifesting ORT secondary to advanced AMD were compared to high-resolution histological sections through the fovea and superior perifovea of donor eyes (13 atrophic AMD and 40 neovascular AMD) preserved ≤4 hours after death. Results ORT seen on OCT corresponded to histologic findings of tubular structures comprised largely of cones lacking outer segments (OS) and lacking inner segments (IS). Four phases of cone degeneration were histologically distinguishable in ORT lumenal walls, nascent, mature, degenerate, and end-stage (IS and OS; IS only; no IS; no photoreceptors and only Müller cells forming external limiting membrane, ELM, respectively). Mitochondria, which are normally long and bundled within IS ellipsoids, were small and scattered within shrunken IS and cell bodies of surviving cones. A lumenal border was delimited by an ELM. ORT observed in closed and open configurations were distinguishable from cysts and photoreceptor islands on both OCT and histology. Hyper-reflective lumenal material seen on OCT represents trapped retinal pigment epithelium (RPE) and non-RPE cells. Conclusions The defining OCT features of ORT are location in the outer nuclear layer (ONL), a hyper-reflective band differentiating it from cysts, and RPE that is either dysmorphic or absent. ORT histologic and OCT findings corresponded in regard to composition, location, shape, and stages of formation. The reflectivity of ORT lumenal walls on OCT apparently does not require an OS or an IS/OS junction, indicating an independent reflectivity source, possibly mitochondria, in the IS.

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“…Approximately 5% of the white population has a choroidal naevus and the risk of A choroidal naevus does not usually warrant treatment, however leakage of fluid into the subretinal space, presence of visual symptoms, secretion of orange-pigmented lipofuscin and/ or growth, raise the suspicion for malignant transformation into choroidal malignant melanoma and need for intervention. Occasionally a naevus will cause symptoms without malignant transformation, such as the onset of choroidal neovascularization [27]. Patients diagnosed from photographic diabetic retinopathy screening with a choroidal naevus should be referred to an ophthalmologist, retinal specialist or even an ocular oncologist depending on the level of suspicion for a complete evaluation.…”

Section: Choroidal Naevusmentioning

confidence: 99%