Optical coherence tomography angiography findings of an optic disc melanocytoma in a glaucoma eye

Evaluation of blood vessel network formation and visual field defect in optic disc melanocytoma

AIM

To investigate the association between visual field defects and blood vessel network (BVN) formation in optic disc melanocytomas (ODMs) using optical coherence tomography angiography (OCTA).

METHODS

Single-centre, retrospective case series of 32 eyes of 32 patients with ODM, in which eyes were divided into two groups based on complete and incomplete BVN formations.

RESULTS

OCTA revealed incomplete BVN formation in 16 of 32 ODMs. The location of BVN absence corresponded to the location of hypofluorescence from fluorescein angiography (FA) in 12 (75%) and to the location of visual field defect in 13 (81%) ODMs in the incomplete BVN group. Perimetric indices were significantly worse in the incomplete BVN group than in the complete BVN group. Linear regression of mean deviation (MD) and Visual Field Index (VFI) on the area of BVN absence were statistically significant (p=0.01 and p=0.003, respectively), whereas linear regressions of MD and VFI on the tumour area were not statistically significant (both p=0.09) in the incomplete BVN group.

CONCLUSION

The location of BVN absence within ODMs corresponded to the location of visual field defect and the location of FA hypofluorescence. Visual field defect was more severe in the incomplete BVN group than in the complete BVN group. Visual field defect was more significantly associated with the area of BVN absence than the tumour area.

Ocular circulation change in optic disc melanocytoma - a case report and a review of the literature

BACKGROUND

Ocular circulation in optic disc melanocytoma (ODM) has not yet been well evaluated. We quantitatively evaluated longitudinal changes in the morphology and circulation hemodynamics of the disc and macula using optical coherence tomography angiography (OCTA) and laser speckle flowgraphy (LSFG) in a patient with optic disc melanocytoma.

CASE PRESENTATION

A 50-year-old woman was referred to our hospital due to a dark pigmented tumor over the superior optic disc area of the left eye noted on physical examination. At the first visit, the patient's best-corrected visual acuity (BCVA) was 20/20 in both eyes, and the intraocular pressure (IOP) was 17 and 18 mmHg in the left and right eyes, respectively. Fluorescein angiography (FA) showed blockage of fluorescence in the topography of the lesion, and indocyanine green angiography (ICGA) showed hypofluorescence at all times. On LSFG, a low mean blur rate (MBR) was noted in the optic disc all area (MBRa) and tissue (MBRt) compared to the contralateral eye at the first visit and at the 3-month follow-up. A relatively low MBR was also detected in the macular area of the affected eye and the tumor itself. OCTA detected blood vessel networks in the deep retinal layer of the tumor. The visual field showed no specific defects. During follow-up, there was no tumor enlargement or vision decrease.

CONCLUSIONS

We found that a lower MBR of the disc and macula area was noted on LSFG in this patient with optic disc melanocytoma, and it was continually observed at the 3-month follow-up. Although blood vessel networks in the deep retinal layer of the tumor were detected by OCTA, vascular compromise in the surrounding disc area and macula was found. Therefore, these results further increase our knowledge about the role that circulation impairment plays in the pathogenesis of the disease while vision is unaffected.

Multimodal imaging of optic disc melanocytoma

PURPOSE

To describe the findings of four patients (four eyes) with optic disc melanocytoma (ODM), using multimodal imaging.

METHODS

Retrospective case series.

RESULTS

On ocular ultrasonography ODMs appeared as hyperechogenic lesions with moderate-to-high internal reflectivity. On blue-light fundus autofluorescence, ODMs showed total hypoautofluorescence, while, on infrared reflectance images appeared as bright and well-marginated lesions. MultiColor composite images showed reddish-brown lesions with well-defined margins. Swept-source optical coherence tomography revealed elevated lesions covering the optic disc with an irregular hyperreflective surface, dishomogeneous internal structure with hyperreflective dots, and posterior shadowing. In all cases optical coherence tomography angiography detected intratumoral blood vessels which were not detectable with fluorescein angiography.

CONCLUSION

Multimodal imaging in ODM might be useful both at presentation, increasing the diagnostic accuracy, and at follow-up, providing helpful details, that can help to rule out the possibility of malignant transformation and other ocular complications.

Multimodal imaging in optic nerve melanocytoma: Optical coherence tomography angiography and other findings

PURPOSE

To evaluate optical coherence tomography (OCT), fundus autofluorescence (FAF) imaging and optical coherence tomography angiography (OCTA) as diagnostic tools in optic disc melanocytoma (ODM) and study the differences in peripapillary and macular vascular density in eyes with ODM using OCTA.

METHODS

Patients with ODM were enrolled in this case series. Each patient underwent evaluation of best-corrected visual acuity, slit-lamp biomicroscopy, fundus examination, fundus photography, standard visual field testing, spectral domain OCT, ultrasound B-scan examination, FAF, fluorescein angiography and OCTA.

RESULTS

Eight patients (three males and five females) with ODM (9 eyes) were enrolled. The largest ODM presented a nodular appearance with a hyper-reflective tumor surface and a posterior optical shadow on OCT. FAF images showed hypoautofluorescence of the tumor with well-defined outlines. Analysis of optic nerve vascular area showed decreased values in the radial peripapillary capillary plexus (3 of 5) and the outer retinal plexus (4 of 5) in the eyes with ODM. In contrast, the ODM eyes had a higher macular vascular area in the deep capillary plexus in 4 of 6 patients.

CONCLUSIONS

ODM may be associated with changes in peripapillary and macular perfusion, with an increase in peripapillary vascularization being a possible risk factor for growth. OCTA might be a helpful objective method in the analysis of changes in flow in patients with ODM.

Swept-source optical coherence tomography angiography findings in choroidal and retinal tumors

OBJECTIVES

To report the swept-source optical coherence tomography angiography (SS-OCTA) findings in choroidal and retinal tumors.

METHODS

A retrospective noncomparative interventional case series of 60 eyes having various choroidal and retinal tumors imaged with SS-OCTA (Topcon DR1 Triton Plus, Tokyo, Japan) between September 2018 and February 2020 was conducted. Inclusion criteria were tumor thickness <4 mm, tumor base diameter <10 mm, and tumor location at the posterior pole.

RESULTS

Choroidal nevi usually demonstrated well-defined borders, hyperreflective internal structure, and no outer retinal involvement on SS-OCTA. Choroidal melanoma, in contrast to nevi, usually had ill-defined borders (p = 0.018), mixed hyperreflective-hyporeflective or hyperreflective internal structure (p = 0.014), and demonstrated outer retinal involvement (p < 0.001). Circumscribed choroidal hemangioma usually presented with well-defined borders, a hyperreflective internal tumor structure with multiple dilated interconnected tumor vessels intermixed with signal void areas representing connective tissue. Optic disc melanocytomas showed a hyporeflective plexus related to blocking of signal by the pigment and an intact radial peripapillary capillary network. There was flow on the surface and slightly deeper within the lesion on B-scan angiography overlay. Retinal astrocytic hamartomas had well-defined borders and a hyperreflective vascular plexus in the superficial and deep retina. Outer retina and choriocapillaris showed hyporeflective change due to shadowing/masking from calcium or high blood flow in the lesion.

CONCLUSIONS

Each of the different retinal and choroidal tumors studied in this series presented with different SS-OCTA features to aid in the differential diagnosis of these conditions. Good quality images are obtained in patients with good fixation and tumors <3 mm in thickness located at the posterior pole.

Optic disc melanocytoma with normal tension glaucoma and angle closure glaucoma: Two case reports

RATIONALE

Optic disc melanocytoma is an ophthalmic tumor that arises from melanocytes, and is a variant of the melanocytic nevus. Here we report 2 cases of optic disc melanocytoma in Asian patient: one associated with normal tension glaucoma (NTG), and the other associated with angle closure glaucoma (ACG).

PATIENT CONCERNS

Case 1 is a 57-year-old Asian female presented to our department for a general ophthalmic examination. Incidentally, brownish pigmented lesion was found on dilated fundus examination of her right eye. The fundus examination and optical coherence tomography (OCT) examination revealed a mass within optic disc, and superotemporal retinal nerve fiber layer (RNFL) thinning. The Humphrey visual field test showed corresponding visual field defect. Fluorescein angiography showed no leakage around the lesion. Case 2 is a 78-year-old Asian woman presented with complaints of acute bilateral ocular pain. The initial examination revealed shallow anterior chamber. Under the impression of intermittent angle closure attack, prophylactic laser peripheral iridotomy were performed. On dilated fundus examination, black pigmented lesion was found at superior sector of optic disc. Further examination revealed bilateral superotemporal, inferotemporal RNFL thinning on OCT, and spatially corresponding visual field defects.

DIAGNOSES

Clinical diagnosis of NTG was made for case 1 patient. Although it was a little distant from typical glaucomatous changes, nevertheless she had RNFL defect compatible with visual field defects. Considering her normal IOP and angle structures, we believe NTG was a probable diagnosis for the patient. In case 2, we made diagnosis of ACG presenting as intermittent angle closure attack because of her presenting symptoms, narrowing of anterior chamber and angle structures found on gonioscopic and slit lamp examinations.

INTERVENTIONS

In Case 1, we prescribe 0.005% latanoprost ophthalmic solution. In Case 2, at first prophylactic laser peripheral iridotomy was performed. Then, topical eyedrops administration was started, and the patient was examined periodically.

OUTCOMES

In Case 1, at 6 months' follow-up, OCT and visual field test showed no progression. In Case 2, to this date, the optic disc melanocytoma remains stable for over a 6-year-follow-up period.

LESSONS

The fact that NTG and ACG can coexist in patients with melanocytoma of optic disc should be recognized, and the possibility of such should appropriately be evaluated.

Swept-source optical coherence tomography imaging of the retinochoroid and beyond

Introduction: Swept-source optical coherence tomography (SS-OCT) imaging has ushered in an era of rapid and high-resolution imaging of the retinochoroid that provides detailed patho-anatomy of various layers.Areas covered: In this detailed review, the technology of swept-source imaging including its principles and working has been discussed. The applications of SS-OCT in various conditions including age-related macular degeneration, diabetic retinopathy, pachychoroid spectrum of diseases, and inflammatory vitreoretinal conditions have been elaborated. For each disease, a brief review of literature along with the utility of SS-OCT and optical coherence tomography angiography has been provided with supporting figures. The advantages of SS-OCT over spectral-domain have been discussed if there is sufficient evidence in the literature. Finally, the review summarizes the technological advantages in this field of retinal imaging.Expert opinion: The introduction of SS-OCT in our clinics has added newer devices in our armamentarium that can provide high-quality images of the deep retina and choroid. These advances in medical devices can help in improving our knowledge relating to the pathophysiology of diseases and their evolution. In the near future, rapid and high-resolution imaging may provide real-time volumetric information of the whole retina and the choroid that can be readily used for patient care.

Comparisons of ganglion cell-inner plexiform layer loss patterns and its diagnostic performance between normal tension glaucoma and primary open angle glaucoma: a detailed, severity-based study

AIM

To evaluate the patterns of macular ganglion cell-inner plexiform layer (GCIPL) loss in normal tension glaucoma (NTG) and primary open angle glaucoma (POAG) in a detailed, disease severity-matched way; and to assess the diagnostic capabilities of GCIPL thickness parameters in discriminating NTG or POAG from normal subjects.

METHODS

A total of 157 eyes of 157 subjects, including 57 normal eyes, 51 eyes with POAG and 49 eyes with NTG were enrolled and strictly matched in age, refraction, and disease severity between POAG and NTG groups. The average, minimum, superotemporal, superior, superonasal, inferonasal, inferior, and inferotemporal GCIPL thickness, and the average, superior, temporal, inferior, and nasal retinal nerve fiber layer (RNFL) thickness were obtained by Cirrus optical coherence tomography (OCT). The diagnostic capabilities of OCT parameters were assessed by area under receiver operating characteristic (AUROC) curves.

RESULTS

Among all the OCT thickness parameters, no statistical significant difference between NTG group and POAG group was found (all P>0.05). In discriminating NTG or POAG from normal subjects, the average and inferior RNFL thickness, and the minimum GCIPL thickness had better diagnostic capabilities. There was no significant difference in AUROC curve between the best GCIPL thickness parameter (minimum GCIPL) and the best RNFL thickness parameter in discriminating NTG (inferior RNFL; P=0.076) and indiscriminating POAG (average RNFL; P=0.913) from normal eyes.

CONCLUSION

Localized GCIPL loss, especially in the inferior and inferotemporal sectors, is more common in NTG than in POAG. Among all the GCIPL thickness parameters, the minimum GCIPL thickness has the best diagnostic performance in differentiating NTG or POAG from normal subjects, which is comparable to that of the average and inferior RNFL thickness.