Original article
Optical Coherence Tomography Enhanced Depth Imaging of Choroidal Tumors

https://doi.org/10.1016/j.ajo.2010.09.028Get rights and content

Purpose

To describe the spectral-domain optical coherence tomography (SD-OCT) features of choroidal tumors imaged using enhanced depth imaging (EDI) technique.

Design

Prospective observational case series.

Methods

One tumor each from 23 eyes of 23 patients was included. All the patients underwent clinical fundus photography, ultrasonography, and EDI SD-OCT. Qualitative characteristics (tumor outline, reflectivity and/or shadowing of choroidal layers, and detection of inner sclera) and quantitative characteristics (measurement of maximum tumor thickness and the largest tumor diameter) were assessed.

Results

Patients (male = 12) were categorized as: amelanotic choroidal nevus (4), melanotic choroidal nevus (9), choroidal melanoma (3), circumscribed choroidal hemangioma (3), and choroidal metastasis (4). In all cases, EDI SD-OCT was able to identify the tumor distinctly from the surrounding normal choroid. Qualitative analysis revealed: amelanotic nevi, homogenous and medium reflective band with visible choroidal vessels; melanotic nevi and choroidal melanomas, high reflective band in the anterior choroid with shadowing, and nonvisualization of choroidal vessels and inner sclera; choroidal hemangiomas, medium/low reflective band without shadowing; and choroidal metastasis, low reflective band in the deep choroid with enlargement of the suprachoroidal space. Maximum tumor diameter and thickness was measurable by EDI SD-OCT only in 10 cases that were <9.0 mm in diameter and <1.0 mm in thickness (undetectable by ultrasonography).

Conclusions

It is possible to obtain cross-sectional views of a variety of choroidal tumors using EDI SD-OCT. Small choroidal tumors nondetectable by ultrasonography can be objectively measured by this technique.

Section snippets

Patients

After Cleveland Clinic Institutional Review Board approval, 23 consecutive patients who met the inclusion criteria were enrolled in the study. Inclusion criteria were: presence of choroidal tumor, evaluated at the Cole Eye Institute (from August to December 2009), age 18 years or more, clear media, posterior location (completely or partially posterior to the vascular arcade), and willingness to sign informed consent. All patients underwent detailed clinical examination including dilated fundus

Results

Twenty-three eyes of 23 patients were included in the study. There were 12 male and 11 female patients. The clinical diagnostic categories for the eyes were amelanotic choroidal nevus (4), melanotic choroidal nevus (9), choroidal melanoma (3), circumscribed choroidal hemangioma (3), and choroidal metastasis (4) (Table 1).

Qualitative analysis revealed that in all cases, EDI SD-OCT was capable of identifying the tumor distinctly from surrounding tissues, including anteriorly from the

Discussion

Optical coherence tomography technology has been described as an important tool for tumor evaluation in ophthalmology, skin cancers,12, 13 and brain tumors.14 In the past, one limitation of this method was inadequate imaging of the choroid, site for the majority of primary and metastatic intraocular tumors. Several authors have described the importance of OCT in evaluating retinal changes in the diagnosis and follow-up of choroidal melanocytic lesions,7, 9, 10, 15 choroidal metastasis,8

Virginia L. L. Torres, MD, is currently professor and head of ocular oncology sector of Eyes Hospital of Pernambuco and Altino Ventura Foundation, Recife, Pernambuco, Brazil. Dr. Torres graduated from medical school (1994) and completed ophthalmology residency (1997) at Federal University of Pernambuco, Brazil. She had a fellowship in retina-vitreous disease training at Federal University of Pernambuco, Brazil (1999) and a medical ocular oncology fellowship and ophthalmic ultrasonography

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    Virginia L. L. Torres, MD, is currently professor and head of ocular oncology sector of Eyes Hospital of Pernambuco and Altino Ventura Foundation, Recife, Pernambuco, Brazil. Dr. Torres graduated from medical school (1994) and completed ophthalmology residency (1997) at Federal University of Pernambuco, Brazil. She had a fellowship in retina-vitreous disease training at Federal University of Pernambuco, Brazil (1999) and a medical ocular oncology fellowship and ophthalmic ultrasonography training at the Federal University of São Paulo, Brazil (2003). She also completed a post-doctoral research fellowship in ocular oncology at the Cleveland Clinic Foundation, Cleveland, Ohio (2009), granted by Brazil′s government agency (CAPES). Dr Torres′s clinical and research expertise is in the area of ocular melanoma, retinoblastoma and tumors of ocular surface.

    Arun D. Singh, MD, is the Director of the Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio. He is Fellow of the Royal College of Ophthalmologists, London, United Kingdom and American Board of Ophthalmology. He has published more than 200 scientific articles in peer reviewed journals and has edited a major text book (Clinical Ophthalmic Oncology) published by Elsevier. He is Editor of the British Journal of Ophthalmology.

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