Fundus autofluorescence and optical coherence tomography findings in choroidal melanocytic lesions

Abstract

Purpose:To establish the characteristics of secondary retinal and retinal pigment epithelial (RPE) changes associated with the presence of choroidal melanoma and choroidal nevus as documented by optical coherence tomography (OCT) and fundus autofluorescence (FAF).Materials and Methods:PubMed review of major English publications examining the correlation between clinical characteristics of choroidal melanoma and nevus with OCT and FAF findings.Results:The intrinsic properties of choroidal melanoma, as well as overlying RPE changes, drusen, and lipofuscin are best characterized by FAF, while OCT is more sensitive for the identification of subretinal and intraretinal fluid as well as atrophy, degeneration, and photoreceptor loss in the neurosensory retina.Conclusions:Secondary retinal changes associated with choroidal melanocytic lesions can be documented by OCT and FAF. OCT-evident changes are observed more often with choroidal melanoma than choroidal nevus. OCT is better suited to identify the overlying retinal detachment and edema, even before these findings are clinically apparent. FAF is most useful in documenting the presence of lipofuscin, a finding that represents one of the important criteria in differentiating small choroidal melanoma from benign choroidal nevus.

Autofluorescence and spectral-domain optical coherence tomography of optic disk melanocytoma

“…FAF findings in ODM differential diagnoses, such as choroidal melanoma and choroidal nevus, have been previously described (5,10,11) . FAF is useful in documenting the presence of lipofuscin, a finding that represents an important criterion in differentiating small choroidal melanoma from benign choroidal nevus (5) .…”

“…FAF is useful in documenting the presence of lipofuscin, a finding that represents an important criterion in differentiating small choroidal melanoma from benign choroidal nevus (5) . Choroidal melanomas have mild autofluorescent properties (granular appearance in 92% of cases and nongranular appearance in 8%) (5) .…”

“…FAF is useful in documenting the presence of lipofuscin, a finding that represents an important criterion in differentiating small choroidal melanoma from benign choroidal nevus (5) . Choroidal melanomas have mild autofluorescent properties (granular appearance in 92% of cases and nongranular appearance in 8%) (5) . Lately, a quantification method of digital autofluorescence was suggested for distinguishing nevi from melanomas with a sensitivity of 0.89 and specificity of 0.93 (12) .…”

“…Lipofuscin is a mixture of proteins, lipids, and small chromophores that accumulate in retinal pigment epithelium (RPE) as a result of incomplete or deficient photoreceptor outer segment degradation (6) . Depending on the intensity of the autofluorescence, a lesion may be described as isoautofluorescent, hypoautofluorescent, or hyperautofluorescent (5) .…”

“…Ancillary procedures, such as fundus photography, fluorescein angiography (FA), and optical coherence tomography (OCT), can help the diagnosis and are useful for follow-up evaluations (1) . Fundus autofluorescence (FAF) is a non-invasive examination based on the fluorescent appearance of lipofuscin when illuminated by an external light source (5) . Lipofuscin is a mixture of proteins, lipids, and small chromophores that accumulate in retinal pigment epithelium (RPE) as a result of incomplete or deficient photoreceptor outer segment degradation (6) .…”