Hyperreflective dots surrounding the central retinal artery and vein in optic disc melanocytoma revealed by spectral domain optical coherence tomography

Abstract

SD OCT provides higher definition images of ODM relating to the branches of the central retinal artery/vein, revealing anterior displacement of vessels and perivascular distribution of hyperreflective dots that suggest melanophages and/or tumor cells or proteins and/or lipid deposits.

Clinical and Spectral-Domain Optical Coherence Tomography Appearance of Optic Disc Melanocytoma: A New Classification and Differentiation from Pigmented Choroidal Lesions

“…The SD-OCT findings of melanoma and nevus we observed were consistent with previous large series [5,6,7,8,9,10,11,12,13,14,15,16,17,18,19]. The heavily pigmented Type 1 optic disc melanocytoma is usually distinguishable from choroidal melanoma and choroidal nevus by funduscopic findings, but SD-OCT may help confirm the diagnosis and identify associated features, such as subretinal fluid, that could affect the clinical course.…”

“…These are summarized in Table 3[5,6,7,8,9,10,11,12,13,14,15,16,17,18,19]. Our cases corroborate a constellation of findings that have previously been reported and that are typical of most heavily pigmented optic disc melanocytomas: a very prominent and dense optical shadowing by the heavily pigmented tumor; a sharply demarcated interface between the tumor and a thin, hyperreflective layer of the disorganized overlying retina, and hyperreflective dots accumulated at the tumor-retina interface.…”

“…Hyperreflective dots have been reported in previous SD-OCT studies of age-related macular degeneration [20], diabetic macular edema, and retinal vein occlusion, as well as optic disc melanocytoma. There has been speculation that they may represent retinal microglial cells activated by the inflammatory process in age-related macular degeneration [20], lipoprotein, or lipid-laden macrophages in diabetic macular edema and retinal vein occlusion, or melanophages, in optic disc melanocytoma [13], consistent with histopathology of optic disc melanocytoma [9]. We postulate that these dots may represent lipoprotein deposits or clumps of macrophages engulfing them due to the disruption of the blood-retinal barrier in the retina disorganized by tumor damage.…”

“…The SD-OCT features of choroidal melanoma and nevus have been well described [1,2,3,4]. While a number of case reports and small case series include limited descriptions of the corresponding features of the classic, darkly pigmented optic disc melanocytoma, these have not included the uncommon, more lightly pigmented form of the tumor [5,6,7,8,9,10,11,12,13,14,15,16,17,18,19]. We compared the features of both the classic, darkly pigmented and the atypical, more lightly pigmented optic disc melanocytoma with those of pigmented choroidal lesions.…”

Swept source optical coherence tomography imaging of optic disc melanocytoma

“…This hypothesis would correspond with descriptions of the tumours on histopathological examination . With regards to the hyperreflective dots spread throughout the surrounding retina and around the blood vessels overlying the ODM, we believe that these may also represent melanin‐phagocytizing macrophages, which are often found in pigmented lesions such where melanophages infiltrate the gliotic, disorganized retina adjacent to the tumour with a predominantly perivascular distribution …”