Potential Pitfalls in Measuring the Thickness of Small Choroidal Melanocytic Tumors With Ultrasonography

Mrejen, Sarah; Fung, Adrian T.; Silverman, Ronald H.; Kendall, Cynthia J.; Freund, K. Bailey

doi:10.1097/iae.0b013e318296f681

Cited by 17 publications

(14 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…3,5 Furthermore, high-resolution EDI-OCT offers accurate assessment of true nevus thickness, precluding overestimation of thickness by comparatively low-resolution ultrasonography technique. 5,9 In this report, we described an observation of choroidal nevus using EDI-OCT, that is, the presence of posterior scleral bowing at the site of the nevus, found in 5% of patients with nevus. This feature is characterized by abrupt posterior excavation in the scleral tissue, most commonly found with choroidal nevus located nearer to the optic disc and foveola compared with a previous large cohort of patients.…”

Section: Discussionmentioning

confidence: 97%

“…10,11 We previously published a report describing a 14year-old patient with ultrasonographic and histopathologic posterior scleral bowing at the site of a 4.9-mm thick choroidal melanoma. 9 Cham and Pavlin 11 provided an analysis of 24 young patients (<30 years old) with choroidal melanoma and found posterior scleral bowing on ultrasonography in 14 (58%). They noted tumor thickness in the group with scleral bowing was less (mean, 4.4 mm) compared with those without this finding (mean, 5.7 mm).…”

Section: Discussionmentioning

confidence: 99%

“…This observation highlights the need to reassess the measurement of small pigmented lesions by ultrasonography vs EDI-OCT as several studies have now shown that EDI-OCT measurements can differ from ultrasonographic measurement. 5,9 It is important to differentiate scleral bowing from true choroidal excavation. The latter is a term describing an ultrasonographic feature seen with choroidal melanoma in which the tumor appears more acoustically hollow than the surrounding choroid.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Posterior Scleral Bowing With Choroidal Nevus on Enhanced-Depth Imaging Optical Coherence Tomography

et al. 2015

View full text Add to dashboard Cite

IMPORTANCE Recognition of posterior scleral bowing with choroidal nevus is essential to avoid an underestimation of tumor thickness. OBJECTIVE To describe a particular observation of posterior scleral bowing associated with choroidal nevus on enhanced-depth imaging (EDI) optical coherence tomography (OCT). DESIGN, SETTING, AND PARTICIPANTS Retrospective observational case series at a referral center involving 17 eyes of 17 patients. Patients were seen from June 2013 to July 2014, with all data collected and analyzed from June 2014 to July 2014. INTERVENTIONS Retrospective medical record review and multimodal imaging including fundus photography, autofluorescence, infrared reflectance, ultrasonography, and EDI-OCT. MAIN OUTCOMES AND MEASURES Clinical and imaging characteristics. RESULTS Analysis of 318 consecutive patients with choroidal nevus imaged over a 1-year period revealed that 17 cases (5%) demonstrated the EDI-OCT feature of posterior scleral bowing. Of these 17 cases, the mean patient age was 58 years (median, 58 years; range, 36-75 years) and there were 6 men (35%) and 11 women (65%). The nevus was classified as pigmented (n = 3; 18%), nonpigmented (n = 2; 12%), and mixed pigmentation (n = 12; 71%), and with no surrounding halo (n = 7; 41%). Associated features included overlying drusen (n = 9; 53%), retinal pigment epithelial alterations (n = 9; 53%), subretinal fluid (n = 5; 29%), and orange pigment (n = 3; 18%). The nevus was clinically estimated to be of 4.91-mm basal dimension and measured ultrasonographically at 1.59-mm thickness. By EDI-OCT, the nevus mean thickness was 628 μm (0.63 mm). All cases demonstrated posterior scleral bowing with mean scleral excavation of 398 μm (median, 377 μm; range, 134-739 μm). Underlying the nevus, the scleral thickness was not measurable; however, at the nevus margin, the choroid and sclera appeared normal. Clinical features correlated with posterior scleral bowing included reduced distance to the optic disc (difference, 1.3 mm; 95% CI, −2.95 mm to 5.51 mm; P = .01) and the foveola (difference, 2.14 mm; 95% CI, 0.80 mm to 3.48 mm; P < .001), as well as the presence of surrounding halo (difference, 36%; 95% CI, 16.86% to 59.27%; P < .001). CONCLUSIONS AND RELEVANCE Choroidal nevus can show focal posterior scleral bowing on EDI-OCT in 5% of cases. This finding was related to more posterior location of nevus, less/mixed pigmentation, and surrounding halo. This finding could lead to underestimation of tumor thickness as the tumor bows backward rather than forward.

show abstract

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Posterior Scleral Bowing With Choroidal Nevus on Enhanced-Depth Imaging Optical Coherence Tomography

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Mrejen et al have explored the disparate measurements of choroidal lesions using EDI-OCT versus ultrasonography. They suggested factors that could lead to pitfalls for choroidal thickness measurement including patient age, globe myopia, diurnal variation of choroidal thickness, variability of scleral thickness, and the difficulty in identification of the posterior choroidalscleral interface on ultrasonography and OCT. 29 By EDI-OCT, choroidal features of melanoma can be similar to nevus with deep optical shadowing (97%) and overlying choriocapillaris compression (100%) 27 (Table 1). Outer retinal features included shaggy photoreceptors (49%) and structural loss of photoreceptors (24%), ellipsoid segment (65%), external limiting membrane (43%), outer nuclear layer (16%), and outer plexiform layer (11%) 27 (Figure 2).…”

Section: Choroid Melanomamentioning

confidence: 99%

Enhanced Depth Imaging Optical Coherence Tomography of Intraocular Tumors

Shields¹,

Pellegrini²,

Ferenczy³

et al. 2014

Retina

116

View full text Add to dashboard Cite

show abstract

“…11 Since the advent of spectral domain optical coherence tomography (SD-OCT) that uses a 830-nm infrared light source, choroidal thinning in highly myopic eyes can be accurately measured with this technology. [10][11][12][13][14]16 In addition, variations in choroidal thickness (CT) can be seen to correlate with age [10][11][12][13][14][15] (15.6 mm decrease in CT per decade of life 11,19,20 ), gender (18% thicker in men 21 ), myopic refraction (8.7 mm reduction per diopter of myopia 11 ), and AL 10,[12][13][14][21][22][23][24][25] ; and evidence suggests that thinner choroids can be a predictor for lacquer crack formation. The SFCT in highly myopic eyes have been found to be in the range of 93.2 mm to 172.9 mm.…”

mentioning

confidence: 99%