Original articleOptical Coherence Tomography Enhanced Depth Imaging of Choroidal Tumors
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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2019, Ophthalmology RetinaCitation Excerpt :Torres et al. demonstrated that choroidal tumors <1 mm in height that were deemed undetectable by ultrasonography could actually be measured with EDI-OCT.8 Because choroidal nevi should undergo appropriate monitoring based on clinical characteristics with the goal of early detection and treatment of those nevi that evolve into uveal melanomas, EDI-OCT may be more sensitive than ultrasonography in monitoring small nevi. With the advancement of SD-OCT to include EDI, we can identify features beyond the anterior surface and can more definitively identify tumor boundaries, including the posterior boundaries of these flat lesions.8 We demonstrated the ability to consistently identify and measure the thickness of ultrasonographically flat choroidal lesions using EDI-OCT in 94% of nevi (3% not visible; 3% with difficult to discern posterior boundary due to heavy shadowing).
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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.