Choroidal Lymphoma: Diagnostic Value of Combined Indocyanine Green Angiography and Optical Coherence Tomography

Choroidal hypopigmented lesions: A review

Choroidal hypopigmented lesions (CHLs) represent significant diagnostic and therapeutic challenges due to their diverse and complex etiologies, including neoplastic, infectious, and inflammatory origins. Accurately differentiating between benign lesions with good prognoses and malignant or life-threatening conditions is crucial in directing the appropriate management and avoiding unnecessary invasive interventions. We integrate the latest research and clinical guidelines on advanced multimodal imaging modalities, emphasizing their comparative diagnostic value across varied etiologies of CHLs. In contrast to prior studies, we comprehensively evaluates the clinical implications of these techniques in accurately differentiating between benign from malignant choroidal lesions. Emphasis is placed on the role of advanced imaging modalities, including swept-source optical coherence tomography, B-scan ultrasound, fundus autofluorescence, fluorescein angiography, and indocyanine green angiography, in enhancing diagnostic precision. These technologies have substantially increased the capability to distinguish between lesion types, improving diagnostic accuracy and giving more targeted therapeutic strategies.

Optical Coherence Tomography in Inflammatory and Neoplastic Lesions Deforming the Choroidal Profile

The choroid is the main part of the uvea, the vascular layer of the eye that lies between the retina and the sclera. The high vascular component of the choroid makes this structure susceptible to inflammation in multisystemic diseases, as well as the most common site of metastasis in the eye. Therefore, the choroid is involved in many pathological conditions, from uveitis to intraocular tumors. Differentiating between inflammatory and neoplastic lesions deforming the choroidal profile can sometimes be challenging. In addition, scleral disorders can also deform the choroidal profile. Choroidal imaging includes ophthalmic ultrasonography, indocyanine green angiography, and optical coherence tomography (OCT). Recent advances in choroidal imaging techniques, such as enhanced depth imaging optical coherence tomography (EDI-OCT) and swept-source optical coherence tomography (SS-OCT), have facilitated an in-depth analysis of the choroid. The purpose of this review article is to report on and highlight the most common OCT findings to help in the differential diagnosis between inflammatory and neoplastic lesions deforming the choroidal profile.

Value of Combined Diagnosis for Choroidal Lymphoma: A Case Report

Intraocular lymphoma (IOL) comprises a group of malignant tumours originating from lymphohematopoietic tissues that have a poor prognosis. These tumours predominantly occur in the vitreous and retina but are rarely found in the choroid. A few case reports and case series of choroidal lymphoma (CL) have been reported in the literature. CL is prone to misdiagnosis and incorrect treatment because it often mimics other intraocular diseases such as uveitis. This may seriously affect localisation of the primary lesion and delay treatment, which may even affect the patient's survival. Herein, we report a case of CL and propose the combination of characteristic ophthalmic imaging with systemic imaging and aqueous humour detection to establish a robust basis for the early diagnosis of CL.

The Role of Optical Coherence Tomography and Optical Coherence Tomography Angiography in the Differential Diagnosis of Posterior Uveitis

PURPOSE

Modalities such as optical coherence tomography (OCT) and OCT angiography (OCTA) have improved the diagnostic utility of fundus imaging in management of uveitis. The purpose of this study is to review role of OCT and OCTA in differential diagnosis of certain posterior uveitic entities.

METHODS

Narrative review.

RESULTS

In this review, we have comprehensively summarized the utility of OCT and OCTA in helping the clinician diagnose common but challenging inflammatory conditions including ocular toxoplasmosis, viral retinitis, and vitreoretinal lymphoma, among others. OCT and OCTA can also be used to assess the choriocapillaris involvement in conditions such as multiple evanescent white dot syndrome, and choroidal granulomas in tubercular and sarcoid uveitis.

CONCLUSIONS

Fundus imaging with OCT and OCTA has assumed a significant role in establishing the diagnosis in uveitis apart from microbiological and other laboratory analysis. Advantages such as rapidity and non-invasiveness make these imaging modalities very useful and convenient.