Fundus Autofluorescence Imaging in Patients with Choroidal Melanoma

Abstract

Choroidal melanocytic lesions require reliable and precise clinical examination and diagnosis to differentiate benign choroidal nevi from choroidal melanoma, as the latter may become life-threatening through metastatic disease. To come to an accurate diagnosis, as well as for monitoring, and to assess the efficacy of therapy, various imaging modalities may be used, one of which is non-invasive fundus autofluorescence (FAF) imaging using novel high-resolution digital imaging technology. FAF imaging is based on the visualization of intrinsic fluorophores in the ocular fundus. Lipofuscin and melanolipofuscin within the postmitotic retinal pigment epithelium (RPE) cells represent the major fluorophores that contribute to the FAF signal. In addition, the presence or loss of absorbing molecular constituents may have an impact on the FAF signal. A choroidal melanoma can cause secondary retinal and RPE alterations that affect the FAF signal (e.g., occurrence of orange pigment). Therefore, FAF imaging supports multimodal imaging and gives additional information over and above conventional imaging modalities regarding retinal metabolism and RPE health status. This article summarises the features of FAF imaging and the role of FAF imaging in the context of choroidal melanoma, both before and following therapeutic intervention.

Retromode Scanning Laser Ophthalmoscopy for Choroidal Nevi: A Preliminary Study

“…IR imaging demonstrated the presence of choroidal nevi in 90.2% of cases, most commonly as hyperreflective areas, which is consistent with findings from prior series [13]. On green autofluorescence, the margins of the lesions were not visible, but this imaging modality was helpful in identifying retinal and RPE changes associated with choroidal nevus, as previously described [28,29].…”

Choroidal Melanocytic Hamartoma

“…Uveal melanomas commonly involve the choroid, and choroidal melanomas are usually described as broad based and elevated pigmented tumors underneath the retina [ 18 , 22 ]. In this series, the lesions were not pigmented on examination and were seen as flat lesions on the OCT scans.…”

Fundus Autofluorescence in Posterior and Panuveitis—An Under-Estimated Imaging Technique: A Review and Case Series

“…The presence of SRF can result in additional FAF findings including hypoautofluorescence due to blockage in cases with recent onset SRF, hyperautofluorescence due to accumulation of fluorophores in the SRF during the course, and hypoautofluorescence due to RPE loss due to persistent SRF in the chronic stage. The FAF patterns in the radiation field following brachytherapy included a rim of hyperautofluorescence at the border of irradiation field and FAF mottling characterized by irregular pattern of hyperautofluorescence with speckled areas of hypoautofluorescence [63,64].…”