Diagnostic of small choroidal metastasis

Abstract

Choroidal metastasis in 23–30 % of cases have multifocal growth. In 10–20 % of patients do not have subjective complaints, due to eccentrical localization of choroidal metastases. In these cases, they are detected by chance during examination. In the literature there is no information on the possibility of early diagnosis of “small” foci of metastatic lesions of the choroid using optical coherence tomography (OCT).The aim. To identify diagnostic signs of “small” choroidal metastases.Materials and methods. The study included 4 patients in whom “small” metastases (15 foci) were not visualized by ultrasound.Results. Choroidal metastases, which were not detected by ultrasound, mainly characterized by a multifocal growth pattern, and located mainly outside the central regions of the fundus. The OCT picture in these cases was characterized by the expansion of the choroidal complex up to 1300 μm with an asymmetric shape of the slopes, irregularities of its anterior surface with a moderate hyporeflective structure. At the same time, Bruch’s membrane was preserved, but a violation of the architectonics of the choriocapillary layer is characteristic with a flat profile of the anterior surface of the sclera. Secondary changes in the proper retina are represented by thickening of the retinal pigment epithelium, edema of the photoreceptor layer and of the nuclear layers, while neuroepithelium detachment (NED) appears mainly when the focus is more than 400 μm thick. Initially, choroidal metastasis can be detected by the fundus examination in MultiColor and OCT, as changes appear in the retina – edema of the photoreceptor layer with hyperreflective inclusions and NED, changes appear in the blue-peak autofluorescence (BAF) – hyperBAF with point hypoBAF inclusions, which leads to a change fundus pictures in MultiColor mode.Conclusion. For all patients with a burdened oncological history, even in the absence of visual complaints, in addition to an examination of the fundus of both eyes, it is necessary to provide an examination of the fundus in MultiColor and short-wave autofluorescence modes, followed by OCT in the zones of changes.