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Mauschitz MM, Zeller M, Sagar P, Biswal S, Guzman G, Terheyden JH, Meyer CH, Holz FG, Heinz C, Pleyer U, Finger RP, Wintergerst MWM. Fundus Autofluorescence in Posterior and Panuveitis-An Under-Estimated Imaging Technique: A Review and Case Series. Biomolecules 2024; 14:515. [PMID: 38785922 PMCID: PMC11118036 DOI: 10.3390/biom14050515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/22/2024] [Accepted: 02/25/2024] [Indexed: 05/25/2024] Open
Abstract
Fundus autofluorescence (FAF) is a prompt and non-invasive imaging modality helpful in detecting pathological abnormalities within the retina and the choroid. This narrative review and case series provides an overview on the current application of FAF in posterior and panuveitis. The literature was reviewed for articles on lesion characteristics on FAF of specific posterior and panuveitis entities as well as benefits and limitations of FAF for diagnosing and monitoring disease. FAF characteristics are described for non-infectious and infectious uveitis forms as well as masquerade syndromes. Dependent on the uveitis entity, FAF is of diagnostic value in detecting disease and following the clinical course. Currently available FAF modalities which differ in excitation wavelengths can provide different pathological insights depending on disease entity and activity. Further studies on the comparison of FAF modalities and their individual value for uveitis diagnosis and monitoring are warranted.
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Affiliation(s)
- Matthias M. Mauschitz
- Department of Ophthalmology, University Hospital Bonn, University of Bonn, 53127 Bonn, Germany
| | - Markus Zeller
- Department of Ophthalmology, University Hospital Bonn, University of Bonn, 53127 Bonn, Germany
| | - Pradeep Sagar
- Sankara Academy of Vision, Sankara Eye Hospital Shimoga, Shimoga 577202, India; (P.S.)
| | - Suchitra Biswal
- Sankara Academy of Vision, Sankara Eye Hospital Shimoga, Shimoga 577202, India; (P.S.)
| | - Gabriela Guzman
- Department of Ophthalmology, University Hospital Bonn, University of Bonn, 53127 Bonn, Germany
| | - Jan H. Terheyden
- Department of Ophthalmology, University Hospital Bonn, University of Bonn, 53127 Bonn, Germany
| | - Carsten H. Meyer
- Augenzentrum Grischun, 7000 Chur, Switzerland
- Department of Ophthalmology, Philipps University, 35037 Marburg, Germany
| | - Frank G. Holz
- Department of Ophthalmology, University Hospital Bonn, University of Bonn, 53127 Bonn, Germany
| | - Carsten Heinz
- Department of Ophthalmology, St. Franziskus-Hospital Muenster, 48145 Muenster, Germany;
- Department of Ophthalmology, University Duisburg-Essen, 45122 Essen, Germany
| | - Uwe Pleyer
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany;
- Department of Ophthalmology, Berlin and Berlin Institute of Health, 13353 Berlin, Germany
| | - Robert P. Finger
- Department of Ophthalmology, University Medical Center Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Maximilian W. M. Wintergerst
- Department of Ophthalmology, University Hospital Bonn, University of Bonn, 53127 Bonn, Germany
- Augenzentrum Grischun, 7000 Chur, Switzerland
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Lupidi M, Centini C, Castellucci G, Nicolai M, Lassandro N, Cagini C, Rizzo C, Chhablani J, Mariotti C. New insights on circumscribed choroidal hemangioma: "bench to bedside". Graefes Arch Clin Exp Ophthalmol 2024; 262:1093-1110. [PMID: 37505277 PMCID: PMC10995022 DOI: 10.1007/s00417-023-06179-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/12/2023] [Accepted: 07/16/2023] [Indexed: 07/29/2023] Open
Abstract
Circumscribed choroidal hemangioma is a rare vascular hamartoma of the choroid, presenting as a red-orange mass at the posterior pole on fundoscopic examination. Despite its benign origin, associated complications such as subretinal fluid, serous retinal detachment, retinoschisis and neovascular glaucoma may lead to serious visual impairment in more than half patients. Because of its similarity to amelanotic choroidal melanoma and choroidal metastasis, differential diagnosis is still challenging for specialists. Multimodal imaging such as ultrasonography, fluorescein angiography, indocyanine green angiography, optical coherence tomography, and optical coherence tomography angiography guides the clinician to the correct diagnosis and the proper follow-up. Treatment is indicated in symptomatic cases in order to resolve exudation and improve visual acuity. Treatment options include photocoagulation, transpupillary thermotherapy, radiation therapy, photodynamic therapy and anti-vascular endothelial growth factor therapy. Currently, photodynamic therapy is the treatment of choice due to its effectiveness and safety. The purpose of this review is to describe the latest knowledge in the etiopathogenesis of the circumscribed choroidal hemangioma, the most recent multimodal imaging findings, and the available treatment options.
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Affiliation(s)
- Marco Lupidi
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy.
- Fondazione Per La Macula Onlus, Dipartimento Di Neuroscienze, Riabilitazione, OftalmologiaGenetica e Scienze Materno-Infantili (DINOGMI), University Eye Clinic, Genoa, Italy.
| | - Chiara Centini
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Greta Castellucci
- Department of Medicine and Surgery, University of Perugia, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Michele Nicolai
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Nicola Lassandro
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Carlo Cagini
- Department of Medicine and Surgery, University of Perugia, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Clara Rizzo
- Ophthalmic Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Jay Chhablani
- Department of Ophthalmology, UPMC Eye Center, University of Pittsburgh, Pittsburgh, USA
| | - Cesare Mariotti
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
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Azzolini C, Di Nicola M, Pozzo Giuffrida F, Cappelli F, Bellina C, Viola F, Chelazzi P. Retromode Scanning Laser Ophthalmoscopy for Choroidal Nevi: A Preliminary Study. Life (Basel) 2023; 13:1253. [PMID: 37374036 DOI: 10.3390/life13061253] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/14/2023] [Accepted: 05/18/2023] [Indexed: 06/29/2023] Open
Abstract
The purpose of the present study was to document pathological findings on retromode imaging in choroidal nevi and evaluate its diagnostic validity, using the confocal scanning laser ophthalmoscope Nidek Mirante (cSLO). A total of 41 choroidal nevi from 41 patients were included. All patients underwent multicolor fundus (mCF), infrared reflectance (IR), green fundus autofluorescence (FAF), dark-field (DF) and retromode (RM) imaging and optical coherence tomography (OCT) scans. We investigated retromode images to evaluate choroidal nevus features by comparing the results with those of mCF, IR, FAF, DF and OCT. In 100% of available images, retromode scanning laser ophthalmoscopy was able to detect choroidal nevi with a characteristic "hypo-retro-reflective" pattern, even the cases not visible on mCF, IR and FAF images. It also made it possible to delineate the margins of lesions with the highest rate of sharpness and accuracy among the imaging modalities examined. These findings seem to demonstrate how RM-SLO is an innovative diagnostic tool to detect and follow up choroidal nevi in a fast, reliable and non-invasive way.
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Affiliation(s)
- Claudia Azzolini
- Department of Ophthalmology, Istituto Clinico Città Studi, 20131 Milan, Italy
| | - Maura Di Nicola
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami 33136, FL, USA
| | - Francesco Pozzo Giuffrida
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Ophthalmological Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Francesca Cappelli
- Department of Ophthalmology, Istituto Clinico Città Studi, 20131 Milan, Italy
| | - Claudia Bellina
- Department of Ophthalmology, Istituto Clinico Città Studi, 20131 Milan, Italy
| | - Francesco Viola
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Ophthalmological Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Paolo Chelazzi
- Department of Ophthalmology, Istituto Clinico Città Studi, 20131 Milan, Italy
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Yuan Y, Li X, Bao X, Huangfu M, Zhang H. The magic mirror: a novel intraoperative monitoring method for parathyroid glands. Front Endocrinol (Lausanne) 2023; 14:1160902. [PMID: 37284221 PMCID: PMC10239973 DOI: 10.3389/fendo.2023.1160902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/01/2023] [Indexed: 06/08/2023] Open
Abstract
The accurate detection of parathyroid glands (PGs) during surgery is of great significance in thyroidectomy and parathyroidectomy, which protects the function of normal PGs to prevent postoperative hypoparathyroidism and the thorough removal of parathyroid lesions. Existing conventional imaging techniques have certain limitations in the real-time exploration of PGs. In recent years, a new, real-time, and non-invasive imaging system known as the near-infrared autofluorescence (NIRAF) imaging system has been developed to detect PGs. Several studies have confirmed that this system has a high parathyroid recognition rate and can reduce the occurrence of transient hypoparathyroidism after surgery. The NIRAF imaging system, like a magic mirror, can monitor the PGs during surgery in real time, thus providing great support for surgeries. In addition, the NIRAF imaging system can evaluate the blood supply of PGs by utilizing indocyanine green (ICG) to guide surgical strategies. The NIRAF imaging system and ICG complement each other to protect normal parathyroid function and reduce postoperative complications. This article reviews the effectiveness of the NIRAF imaging system in thyroidectomies and parathyroidectomies and briefly discusses some existing problems and prospects for the future.
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Hage DG, Wahab CH, Kheir WJ. Choroidal sarcoid granuloma: a case report and review of the literature. J Ophthalmic Inflamm Infect 2022; 12:31. [PMID: 36173484 PMCID: PMC9521566 DOI: 10.1186/s12348-022-00309-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Choroidal sarcoid granulomas are often diagnosed in patients without a prior history of sarcoidosis. They are often mistaken for choroidal metastasis, choroidal nevi, amelanotic choroidal melanomas, and uveal lymphomas; however, are easily treatable when accurately identified. OBSERVATIONS We searched PubMed, Medline, and Scopus for English-Language case reports published before September 2021. Additionally, we presented a case of a 45-year-old woman with a right-sided amelanotic choroidal mass whose diagnosis was delayed by a COVID-19 infection. Of the 26 cases reported in the literature, 46% were female, 38% were African American, and 19% had bilateral involvement. There was a mean age of 42.15 years and a mean follow-up period of 27 months. The most common complaint was of a progressive, painless blurring of vision, and only five patients had been previously diagnosed with sarcoidosis. The choroidal granulomas were typically described as yellow lesions, single or multiple, found temporal to or at the macula. Most patients were administered steroids, with 69% receiving them systemically, 5% topically, and 8% locally with a triamcinolone injection. All patients reported symptomatic improvement at their final follow-up with resolution of the mass in 65% of patients and improved visual acuity in 76%. CONCLUSION Primary testing including fundoscopy, fluorescein angiography, fundus autofluorescence, A/B-scan, and OCT are useful for diagnosis, differentiation from other choroidal lesions, and monitoring treatment response. Steroids are a mainstay of treatment for sarcoidosis and are effective at treating choroidal granulomas. Therefore, early recognition and diagnosis of choroidal granulomas is imperative as treatment can be curative and sight-sparing.
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Affiliation(s)
- Dany G Hage
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Charbel H Wahab
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Wajiha J Kheir
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon.
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Solnik M, Paduszyńska N, Czarnecka AM, Synoradzki KJ, Yousef YA, Chorągiewicz T, Rejdak R, Toro MD, Zweifel S, Dyndor K, Fiedorowicz M. Imaging of Uveal Melanoma—Current Standard and Methods in Development. Cancers (Basel) 2022; 14:cancers14133147. [PMID: 35804919 PMCID: PMC9265106 DOI: 10.3390/cancers14133147] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/06/2022] [Accepted: 06/13/2022] [Indexed: 11/19/2022] Open
Abstract
Simple Summary Uveal melanoma is the most prevalent intraocular tumor in adults, derived from melanocytes; the liver is the most common site of its metastases. Due to troublesome tumor localization, different imaging techniques are utilized in diagnostics, i.e., fundus imaging (FI), ultrasonography (US), optical coherence tomography (OCT), single-photon emission computed tomography (SPECT), positron emission tomography/computed tomography (PET/CT), magnetic resonance imaging (MRI), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), or fundus autofluorescence (FAF). Specialists eagerly use these techniques, but sometimes the precision and quality of the obtained images are imperfect, raising diagnostic doubts and prompting the search for new ones. In addition to analyzing the currently utilized methods, this review also introduces experimental techniques that may be adapted to clinical practice in the future. Moreover, we raise the topic and present a perspective for personalized medicine in uveal melanoma treatment. Abstract Uveal melanoma is the most common primary intraocular malignancy in adults, characterized by an insidious onset and poor prognosis strongly associated with tumor size and the presence of distant metastases, most commonly in the liver. Contrary to most tumor identification, a biopsy followed by a pathological exam is used only in certain cases. Therefore, an early and noninvasive diagnosis is essential to enhance patients’ chances for early treatment. We reviewed imaging modalities currently used in the diagnostics of uveal melanoma, including fundus imaging, ultrasonography (US), optical coherence tomography (OCT), single-photon emission computed tomography (SPECT), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), fundus autofluorescence (FAF), as well as positron emission tomography/computed tomography (PET/CT) or magnetic resonance imaging (MRI). The principle of imaging techniques is briefly explained, along with their role in the diagnostic process and a summary of their advantages and limitations. Further, the experimental data and the advancements in imaging modalities are explained. We describe UM imaging innovations, show their current usage and development, and explain the possibilities of utilizing such modalities to diagnose uveal melanoma in the future.
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Affiliation(s)
- Małgorzata Solnik
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland; (M.S.); (N.P.)
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 5 Roentgen Str., 02-781 Warsaw, Poland;
| | - Natalia Paduszyńska
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland; (M.S.); (N.P.)
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 5 Roentgen Str., 02-781 Warsaw, Poland;
| | - Anna M. Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 5 Roentgen Str., 02-781 Warsaw, Poland;
- Department of Experimental Pharmacology, Mossakowski Medical Research Institute, Polish Academy of Sciences, 5 Pawinskiego Str., 02-106 Warsaw, Poland
| | - Kamil J. Synoradzki
- Department of Experimental Pharmacology, Mossakowski Medical Research Institute, Polish Academy of Sciences, 5 Pawinskiego Str., 02-106 Warsaw, Poland
- Small Animal Magnetic Resonance Imaging Laboratory, Mossakowski Medical Research Institute, Polish Academy of Sciences, 5 Pawinskiego Str., 02-106 Warsaw, Poland;
- Correspondence:
| | - Yacoub A. Yousef
- Department of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman 11941, Jordan;
| | - Tomasz Chorągiewicz
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, Chmielna 1, 20-079 Lublin, Poland; (T.C.); (R.R.); (M.D.T.)
| | - Robert Rejdak
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, Chmielna 1, 20-079 Lublin, Poland; (T.C.); (R.R.); (M.D.T.)
| | - Mario Damiano Toro
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, Chmielna 1, 20-079 Lublin, Poland; (T.C.); (R.R.); (M.D.T.)
- Eye Clinic, Public Health Department, Federico II University, via Pansini 5, 80131 Naples, Italy
| | - Sandrine Zweifel
- Department of Ophthalmology, University of Zurich, 8091 Zurich, Switzerland;
| | - Katarzyna Dyndor
- Department of Radiography, Medical University of Lublin, 8 Jaczewskiego Str., 20-090 Lublin, Poland;
| | - Michał Fiedorowicz
- Small Animal Magnetic Resonance Imaging Laboratory, Mossakowski Medical Research Institute, Polish Academy of Sciences, 5 Pawinskiego Str., 02-106 Warsaw, Poland;
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Bindewald-Wittich A, Holz FG, Ach T, Fiorentzis M, Bechrakis NE, Willerding GD. Fundus Autofluorescence Imaging in Patients with Choroidal Melanoma. Cancers (Basel) 2022; 14:cancers14071809. [PMID: 35406581 PMCID: PMC8997882 DOI: 10.3390/cancers14071809] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 12/15/2022] Open
Abstract
Simple Summary The ocular fundus contains molecules that emit fluorescence when excited with light of an appropriate wavelength. Fundus autofluorescence imaging is based on the in vivo detection of intrinsic fluorescence and results in topographic autofluorescence mapping of the ocular fundus. In contrast to fluorescence angiography, where the fluorescing agents need to be administered intravenously, autofluorescence imaging is a non-invasive technique. Even though choroidal melanomas do not contain significant autofluorescent molecules themselves, they may lead to secondary alterations in neighbouring tissues with an impact on the autofluorescence signal recording. Fundus autofluorescence imaging in the context of choroidal melanoma is helpful for differential diagnosis and for monitoring variations over time in affected patients before and after treatment. Abstract Choroidal melanocytic lesions require reliable and precise clinical examination and diagnosis to differentiate benign choroidal nevi from choroidal melanoma, as the latter may become life-threatening through metastatic disease. To come to an accurate diagnosis, as well as for monitoring, and to assess the efficacy of therapy, various imaging modalities may be used, one of which is non-invasive fundus autofluorescence (FAF) imaging using novel high-resolution digital imaging technology. FAF imaging is based on the visualization of intrinsic fluorophores in the ocular fundus. Lipofuscin and melanolipofuscin within the postmitotic retinal pigment epithelium (RPE) cells represent the major fluorophores that contribute to the FAF signal. In addition, the presence or loss of absorbing molecular constituents may have an impact on the FAF signal. A choroidal melanoma can cause secondary retinal and RPE alterations that affect the FAF signal (e.g., occurrence of orange pigment). Therefore, FAF imaging supports multimodal imaging and gives additional information over and above conventional imaging modalities regarding retinal metabolism and RPE health status. This article summarises the features of FAF imaging and the role of FAF imaging in the context of choroidal melanoma, both before and following therapeutic intervention.
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Affiliation(s)
- Almut Bindewald-Wittich
- Augenkompetenz Zentren Heidenheim, 89518 Heidenheim, Germany
- Augenkompetenz Zentren Bopfingen, 73441 Bopfingen, Germany
- Department of Ophthalmology, University of Bonn, 53127 Bonn, Germany; (F.G.H.); (T.A.)
- Correspondence:
| | - Frank G. Holz
- Department of Ophthalmology, University of Bonn, 53127 Bonn, Germany; (F.G.H.); (T.A.)
| | - Thomas Ach
- Department of Ophthalmology, University of Bonn, 53127 Bonn, Germany; (F.G.H.); (T.A.)
| | - Miltiadis Fiorentzis
- Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (M.F.); (N.E.B.)
| | - Nikolaos E. Bechrakis
- Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (M.F.); (N.E.B.)
| | - Gregor D. Willerding
- Department of Ophthalmology, DRK Kliniken Berlin Westend, 14050 Berlin, Germany;
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Flores dos Santos LC, Fernandes JR, Lima IFP, Bittencourt LDS, Martins MD, Lamers ML. Applicability of autofluorescence and fluorescent probes in early detection of oral potentially malignant disorders: a systematic review and meta-data analysis. Photodiagnosis Photodyn Ther 2022; 38:102764. [DOI: 10.1016/j.pdpdt.2022.102764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 12/24/2022]
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Tserevelakis GJ, Mavrakis KG, Pantazopoulou D, Lagoudaki E, Detorakis E, Zacharakis G. Hybrid autofluorescence and photoacoustic label-free microscopy for the investigation and identification of malignancies in ocular biopsies. OPTICS LETTERS 2020; 45:5748-5751. [PMID: 33057275 DOI: 10.1364/ol.403435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/13/2020] [Indexed: 06/11/2023]
Abstract
We demonstrate the development and application of a prototype hybrid microscopy system integrating autofluorescence (AF) and photoacoustic (PA) label-free contrast modes, for the differentiation of ocular tumors in human surgical biopsies. Hybrid imaging was performed in conjunctival nevi and uveal melanomas tissue sections to acquire quantified data for each molecular background. The AF and PA signals were spatially correlated to establish a novel malignancy indicator that could detect melanomas with high accuracy (t-test; p<0.01). The proposed methodology has the potential to simplify relevant diagnostic procedures and paves the way for the development of novel ophthalmoscopes aiming to the early diagnosis of ocular malignancies in a clinical setting.
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Schmitz-Valckenberg S, Pfau M, Fleckenstein M, Staurenghi G, Sparrow JR, Bindewald-Wittich A, Spaide RF, Wolf S, Sadda SR, Holz FG. Fundus autofluorescence imaging. Prog Retin Eye Res 2020; 81:100893. [PMID: 32758681 DOI: 10.1016/j.preteyeres.2020.100893] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/20/2020] [Accepted: 07/25/2020] [Indexed: 12/20/2022]
Abstract
Fundus autofluorescence (FAF) imaging is an in vivo imaging method that allows for topographic mapping of naturally or pathologically occurring intrinsic fluorophores of the ocular fundus. The dominant sources are fluorophores accumulating as lipofuscin in lysosomal storage bodies in postmitotic retinal pigment epithelium cells as well as other fluorophores that may occur with disease in the outer retina and subretinal space. Photopigments of the photoreceptor outer segments as well as macular pigment and melanin at the fovea and parafovea may act as filters of the excitation light. FAF imaging has been shown to be useful with regard to understanding of pathophysiological mechanisms, diagnostics, phenotype-genotype correlation, identification of prognostic markers for disease progression, and novel outcome parameters to assess efficacy of interventional strategies in chorio-retinal diseases. More recently, the spectrum of FAF imaging has been expanded with increasing use of green in addition to blue FAF, introduction of spectrally-resolved FAF, near-infrared FAF, quantitative FAF imaging and fluorescence life time imaging (FLIO). This article gives an overview of basic principles, FAF findings in various retinal diseases and an update on recent developments.
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Affiliation(s)
- Steffen Schmitz-Valckenberg
- Department of Ophthalmology, University of Bonn, Bonn, Germany; John A. Moran Eye Center, University of Utah, Salt Lake City, USA
| | - Maximilian Pfau
- Department of Ophthalmology, University of Bonn, Bonn, Germany; Department of Biomedical Data Science, Stanford University, USA
| | | | - Giovanni Staurenghi
- Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital University of Milan, Italy
| | - Janet R Sparrow
- Departments of Ophthalmology and Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Almut Bindewald-Wittich
- Department of Ophthalmology, University of Bonn, Bonn, Germany; Augenheilkunde Heidenheim MVZ, Heidenheim, Germany
| | - Richard F Spaide
- Vitreous Retina Macula Consultants of New York, New York, NY, USA
| | - Sebastian Wolf
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Srinivas R Sadda
- Doheny Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany.
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Bindewald-Wittich A, Swenshon T, Carasco E, Dreyhaupt J, Willerding GD. Blue-Light Fundus Autofluorescence Imaging following Ruthenium-106 Brachytherapy for Choroidal Melanoma. Ophthalmologica 2020; 243:303-315. [PMID: 31940652 DOI: 10.1159/000504715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 11/08/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To describe changes in blue-light fundus autofluorescence (FAF) and corresponding alterations in optical coherence tomography (OCT) within the irradiation field after ruthenium-106 brachytherapy (RBT) for choroidal melanoma. METHODS Consecutive patients with choroidal melanoma were included in a retrospective case series. Patients were treated with RBT at a single institution. As part of their routine examination patients underwent multimodal imaging including ultrasonography, fundus photography, OCT, and FAF imaging (excitation = 488 nm). FAF images were analysed for changes within the irradiation field. RESULTS 31 patients (mean age 65.7 years) were treated with RBT for unilateral choroidal melanoma. Mean tumour height before therapy was 2.7 mm (SD 1.0). Mean follow-up time was 23.3 months (SD 13.3). Main FAF characteristics attributable to RBT emerged as increased FAF with speckled decreased FAF (FAF mottling) within the irradiation field and a rim of increased FAF at its border. OCT scans demonstrated loss of the ellipsoid zone and the external limiting membrane, thinning of the neurosensory retina, and alterations of the retinal pigment epithelium like clumping, migration, and atrophy. CONCLUSIONS FAF changes in the irradiation field after RBT of choroidal melanomas follow a characteristic pattern that correlates with distinct OCT alterations. FAF and OCT imaging give additional information to monitor effects of RBT and, therefore, complement multimodal imaging techniques after plaque therapy.
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Affiliation(s)
- Almut Bindewald-Wittich
- Augenheilkunde Heidenheim MVZ GmbH, Heidenheim, Germany.,Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Tomasz Swenshon
- Department of Ophthalmology, DRK Kliniken Berlin Westend, Berlin, Germany
| | - Eva Carasco
- Department of Ophthalmology, DRK Kliniken Berlin Westend, Berlin, Germany
| | - Jens Dreyhaupt
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
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Harbour JW, Paez-Escamilla M, Cai L, Walter SD, Augsburger JJ, Correa ZM. Are Risk Factors for Growth of Choroidal Nevi Associated With Malignant Transformation? Assessment With a Validated Genomic Biomarker. Am J Ophthalmol 2019; 197:168-179. [PMID: 30195895 PMCID: PMC6291343 DOI: 10.1016/j.ajo.2018.08.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/23/2018] [Accepted: 08/23/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE To test the hypothesis that widely used clinical risk factors for growth of choroidal nevi are associated with malignant transformation. METHODS Fine needle biopsy for assignment of gene expression profile (class 1 or class 2) was performed in 207 choroidal melanocytic tumors < 3.5 mm in thickness. The class 2 profile was employed as a validated biomarker for malignant transformation. The following data were collected: patient age and sex, tumor diameter and thickness, distance of posterior tumor margin from the optic disc, and the presence or absence of serous retinal detachment, orange lipofuscin pigment, drusen, retinal pigment epithelial fibrosis, retinal pigment epithelial atrophy, visual symptoms, and documented tumor growth. RESULTS Clinical features associated with the class 2 profile included patient age > 60 years and tumor thickness > 2.25 mm (Fisher exact test, P = .002 for both). Documented growth was not associated with the class 2 profile (P = .5). The odds ratio of a tumor having the class 2 profile was 2.8 (95% confidence interval 1.3-5.9) for patient age > 60 years and 3.5 (95% confidence interval 1.4-8.8) for tumor thickness > 2.25 mm. For patients with both risk factors, the "number needed to treat" to identify 1 patient with a class 2 tumor was 4.3 (P = .0002). No other clinical feature or combination of features was associated with the class 2 profile. CONCLUSIONS None of the widely used choroidal nevus risk factors for tumor growth, nor documented growth itself, is pathognomonic of malignant transformation as defined by class 2 gene expression profile. Patient age and tumor thickness may be helpful for identifying small choroidal melanocytic tumors that are more likely to have the class 2 profile. Observation for growth prior to treatment continues to be reasonable for most patients with suspicious choroidal nevi. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- J William Harbour
- Ocular Oncology Service, Bascom Palmer Eye Institute and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA.
| | - Manuel Paez-Escamilla
- Ocular Oncology Service, Bascom Palmer Eye Institute and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Louis Cai
- Ocular Oncology Service, Bascom Palmer Eye Institute and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Scott D Walter
- Ocular Oncology Service, Bascom Palmer Eye Institute and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - James J Augsburger
- Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Zelia M Correa
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
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Cennamo G, Romano MR, Velotti N, Breve MA, de Crecchio G, Cennamo G. Fundus autofluorescence of choroidal nevi and melanoma. Acta Ophthalmol 2018; 96:e102-e104. [PMID: 28205424 DOI: 10.1111/aos.13413] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Gilda Cennamo
- Eye Clinic - Department of Neurosciences; Reproductive Sciences and Dentistry; University of Naples Federico II; Naples Italy
| | - Mario R. Romano
- Eye Clinic - Department of Neurosciences; Reproductive Sciences and Dentistry; University of Naples Federico II; Naples Italy
| | - Nunzio Velotti
- Eye Clinic - Department of Neurosciences; Reproductive Sciences and Dentistry; University of Naples Federico II; Naples Italy
| | - Maria Angelica Breve
- Eye Clinic - Department of Neurosciences; Reproductive Sciences and Dentistry; University of Naples Federico II; Naples Italy
| | - Giuseppe de Crecchio
- Eye Clinic - Department of Neurosciences; Reproductive Sciences and Dentistry; University of Naples Federico II; Naples Italy
| | - Giovanni Cennamo
- Eye Clinic - Department of Neurosciences; Reproductive Sciences and Dentistry; University of Naples Federico II; Naples Italy
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Kaur G, Anthony SA. Multimodal imaging of suspicious choroidal neoplasms in a primary eye-care clinic. Clin Exp Optom 2017; 100:549-562. [PMID: 28370509 DOI: 10.1111/cxo.12537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 01/05/2017] [Indexed: 11/28/2022] Open
Abstract
Small suspicious choroidal neoplasms commonly present a diagnostic challenge in primary eye-care clinics, where they are most likely to present. Differentiating benign from malignant choroidal neoplasms is essential for facilitating early diagnosis and treatment, potentially decreasing the risk of metastasis and vision loss in some cases. The purpose of this review is to describe the clinical, spectral-domain optical coherence tomography and fundus autofluorescence features of suspicious choroidal neoplasms in a case series of patients presenting to a primary eye-care clinic at the Veterans Health Administration, Cleveland, Ohio, USA.
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Affiliation(s)
- Gurpinderjeet Kaur
- Optometry Clinic, Louis Stokes Cleveland Veterans Affairs Medical Centre, Cleveland, Ohio, USA
| | - Scott A Anthony
- Optometry Clinic, Louis Stokes Cleveland Veterans Affairs Medical Centre, Cleveland, Ohio, USA
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Rishi P, Koundanya VV, Shields CL. Using risk factors for detection and prognostication of uveal melanoma. Indian J Ophthalmol 2016; 63:110-6. [PMID: 25827540 PMCID: PMC4399118 DOI: 10.4103/0301-4738.154373] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The early detection of malignancy, particularly uveal melanoma, is crucial in protecting visual acuity, salvaging the eye, and preventing metastasis. Risk factors for early detection of uveal melanoma have been clearly delineated in the literature and allow identification of melanoma when it is tiny and simulates a nevus. These factors include thickness >2 mm, presence of subretinal fluid (SRF), symptoms, the orange pigment, margin near optic disc, acoustic hollowness, surrounding halo, and absence of drusen. The importance of early detection is realized when one considers melanoma thickness, as each millimeter increase in melanoma thickness imparts 5% increased risk for metastatic disease. Newer imaging modalities like enhanced depth imaging optical coherence tomography and fundus autoflouroscence facilitate in detection of SRF and orange pigment. Additional molecular biomarkers and cytological features have been identified which can predict the clinical behavior of a small melanocytic lesion. Features that suggest a poor prognosis include higher blood levels of tyrosinase m-RNA, vascular endothelial growth factor, insulin-like growth factor; monosomy 3 and gains in chromosome 8. Management of uveal melanoma includes enucleation (for large), local eye wall resection, brachytherapy, charged particle irradiation, and thermotherapy (for small to medium tumors). Although the role of a good clinical evaluation cannot be underestimated, it is advisable to evaluate the various radiological, molecular, and cytological features, to enhance the accuracy of early diagnosis and improved prognosis.
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Affiliation(s)
- Pukhraj Rishi
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Abstract
Fundus autofluorescence (FAF) is a relatively new imaging technique that can be used to study retinal diseases. It provides information on retinal metabolism and health. Several different pathologies can be detected. Peculiar AF alterations can help the clinician to monitor disease progression and to better understand its pathogenesis. In the present article, we review FAF principles and clinical applications.
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Affiliation(s)
| | | | - Paolo Lanzetta
- Department of Medical and Biological Sciences - Ophthalmology, University of Udine, Udine; Istituto Europeo di Microchirurgia Oculare, Udine, Italy
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Samuelsson D, Sznage M, Engelsberg K, Wittström E. Clinical, optical coherence tomography, and fundus autofluorescence findings in patients with intraocular tumors. Clin Ophthalmol 2016; 10:1953-1964. [PMID: 27784984 PMCID: PMC5063485 DOI: 10.2147/opth.s109222] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To describe clinical, optical coherence tomography (OCT) and fundus autofluorescence (FAF) findings in patients with intraocular tumors and determine if OCT and FAF could be helpful in the differential diagnosis and management of different choroidal tumors. METHODS Forty-nine patients with untreated, macular, midperipheral, and extrapapillary intraocular tumors were included. All patients underwent ophthalmic examination: best-corrected visual acuity, slit-lamp biomicroscopy, funduscopy, and standardized B mode, and if possible A mode, ultrasonography, and OCT and FAF imaging of the surface of the intraocular tumors. RESULTS Of the 49 patients studied, 19 had choroidal nevi, ten had indeterminate choroidal melanocytic lesions (IMLs), ten had malignant melanomas, and ten had other choroidal tumors. The choroidal nevi revealed subretinal fluid (SRF) on OCT in only 11%. FAF detected isoauto-fluorescence in 42%, hypoautofluorescence in 37%, patchy FAF pattern in 16%, and a diffuse FAF pattern in 5%. Seventy percent of patients with IML showed SRF on OCT and 20% showed tumor growth on follow-up, detected only by OCT and FAF imaging. FAF revealed a patchy pattern in 50% and a diffuse pattern in 40% of cases with IML. Ninety percent of the patients with choroidal melanoma had SRF on OCT and FAF revealed a patchy pattern in 60% and a diffuse pattern in 40%. Patients with other choroidal tumors had SRF on OCT in 30% of cases and no characteristic pattern on FAF. CONCLUSION Both OCT and FAF were helpful in the differential diagnosis of choroidal nevi versus IMLs, choroidal melanomas, and other choroidal tumors. Also, detailed and periodical clinical evaluation of patients with intraocular tumors using OCT and FAF imaging for the detection of both SRF and FAF patterns overlying the tumor can be useful for detection of tumor growth.
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Affiliation(s)
- Daniel Samuelsson
- Department of Ophthalmology, Lund University, Skane University Hospital, Lund, Sweden
| | - Monika Sznage
- Department of Ophthalmology, Lund University, Skane University Hospital, Lund, Sweden
| | - Karl Engelsberg
- Department of Ophthalmology, Lund University, Skane University Hospital, Lund, Sweden
| | - Elisabeth Wittström
- Department of Ophthalmology, Lund University, Skane University Hospital, Lund, Sweden
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Vallabh NA, Sahni JN, Parkes CK, Czanner G, Heimann H, Damato B. Near-infrared reflectance and autofluorescence imaging characteristics of choroidal nevi. Eye (Lond) 2016; 30:1593-1597. [PMID: 27589052 DOI: 10.1038/eye.2016.183] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 06/28/2016] [Indexed: 02/03/2023] Open
Abstract
PurposeTo report near-infrared reflectance (NIR-R), near-infrared autofluorescence (NIR-AF) and blue wave autofluorescence (BW-AF) appearance of choroidal nevi using a confocal scanning laser ophthalmoscope (cSLO).Patients and methodsNIR-R, NIR-AF and BW-AF images of choroidal nevi were compared with color fundus photos (CF). Images were graded as hyperreflective if reflectance was much greater than background, hyporeflective if less than background, and isoreflective if the same as the background.ResultsForty-two nevi of 39 patients were imaged. When compared with CF, nevi could be identified on 95% (40/42) NIR-R images (95% CI: 83.5-99.3). On NIR-R 71% (30/42) demonstrated hyperreflectance and 24% (10/42) were hyporeflective. Hyperreflectivity was demonstrated in 96% (23/24) of NIR-AF images (95% CI: 79.1-99.9) and 34% (14/41) of BW-AF images (95% CI: 20.0-50.5). On NIR-R, 29/40 (73%) were apparently smaller in comparison with CF and 11/40 (28%) had the same area. A correlation was found between NIR-R and NIR-AF (P=0.02) but not with BW-AF (P=0.15).ConclusionsNevi can be visualized well using NIR-R and NIR-AF imaging modalities, but are less frequently visible using BW-AF. These changes may be related to melanin within the choroid or chronic changes of the overlying retinal pigment epithelium.
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Affiliation(s)
- N A Vallabh
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.,St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - J N Sahni
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.,St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - C K Parkes
- St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - G Czanner
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - H Heimann
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.,St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - B Damato
- Department of Eye and Vision Science, Institute of Ageing and Chronic Disease, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.,University of California, San Francisco, CA, USA
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Paul Brett J, Lake A, Downes S. Colour imaging in the monitoring and documentation of choroidal naevi. Are Optomap colour images adequate for this purpose? J Vis Commun Med 2016; 39:10-7. [PMID: 27253508 DOI: 10.1080/17453054.2016.1182476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
An audit project to evaluate and compare three different imaging systems used to photograph choroidal naevi and to determine whether the Optos Optomap(®) can be used as the only colour image capture system for monitoring and documenting choroidal naevi. A further aim was to assess whether existing protocols could be improved to accurately document position and appearance of choroidal naevi. Twenty patients with choroidal naevi were photographed on three different colour image capture systems. Colour images were taken on the Optomap(®) wide field P200MA camera; the Zeiss FF450plus(®) mydriatic camera and the Topcon TRC-NW6S(®). All images were reviewed retrospectively by a medical retina consultant (SD) who completed a questionnaire to determine the most effective photographic system(s) in demonstrating the location of the naevi and the features of the condition. The Optomap(®) was the most effective in pinpointing the location of the naevus and the Zeiss FF450plus mydriatic camera best captured the features of the naevus. The non-mydriatic camera was rated the least satisfactory for both tasks. The location of the naevus on the retina should determine the choice of modality. If it is possible to photograph the lesion and include the optic disc or central macula, then the mydriatic camera is considered the best modality for recording both the position and features of the pathology. However, if it is not possible, because of the location, to include both the disc or central macula with the lesion in the same frame, then the Optomap(®) should be used to photograph the naevus to record its position and ideally a colour image on the mydriatic camera should also be taken to record the appearance of the lesion.
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Affiliation(s)
- Jonathan Paul Brett
- a John Radcliffe Hospital, Eye Research Group Oxford, Oxford Eye Hospital , Oxford , UK
| | - Amy Lake
- b School of Healthcare Studies , Medical Illustration, Cardiff University , Ty Dewi Sant, Heath Park Campus , Cardiff , UK
| | - Susan Downes
- a John Radcliffe Hospital, Eye Research Group Oxford, Oxford Eye Hospital , Oxford , UK ;,c Nuffield Department of Ophthalmology , John Radcliffe Hospital, University of Oxford , Oxford , UK
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Garcia MD, Salomao DR, Marmorstein AD, Pulido JS. Histopathologic Findings in the Areas of Orange Pigment Overlying Choroidal Melanomas. Transl Vis Sci Technol 2016; 5:4. [PMID: 27190699 PMCID: PMC4867953 DOI: 10.1167/tvst.5.3.4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 02/06/2016] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Orange pigment is an important sign of malignancy in melanocytic tumors. There is a question as to whether the pigment accumulation is inside of macrophages or retinal pigment epithelial (RPE) cells. We investigated which cells are involved with this color alteration. METHODS We examined enucleated specimens from two patients with choroidal melanoma and dense orange pigment on fundus examination. Color fundus and fundus autofluorescence (FAF) photographs were reviewed followed by examination with fluorescent microscopy, electron microscopy, and immunohistochemistry of enucleated eyes for the specific areas corresponding to the orange pigment. RESULTS Orange pigment was observed on color fundus photography and correlated with areas of hyperautofluorescence on FAF. Fluorescent microscopy of sections of the enucleated eyes showed autofluorescence in the RPE, which were most pronounced where there was a localized retinal detachment and reactive hyperplasia of the RPE. Immunohistochemical studies were done with keratin (OSCAR and AE1/AE3) and S-100 stained RPE cells, which still were attached to Bruch's membrane. Histiocytes present in the detached retina stained with anti-CD163 antibody and did not show autofluorescence. Electron microscopy studies of the same areas showed the presence of lipofuscin and melanolipofuscin within the clustered RPE cells. CONCLUSIONS Orange pigment in choroidal melanocytic lesions originates from the RPE cells, rather than macrophages, and is most abundant where there is proliferation of the RPE. TRANSLATIONAL RELEVANCE The orange pigment tumoral biomarker arises and is in the retinal pigment epithelium.
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Affiliation(s)
- Maria D Garcia
- Department of Mayo Medical School, Mayo Clinic, Rochester, MN, USA
| | - Diva R Salomao
- Department of Anatomic Pathology, , Mayo Clinic, Rochester, MN, USA
| | | | - Jose S Pulido
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA ; Department of Molecular Medicine, Mayo Clinic, Rochester, MN, USA
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COMPARATIVE STUDY BETWEEN FUNDUS AUTOFLUORESCENCE AND RED REFLECTANCE IMAGING OF CHOROIDAL NEVI USING ULTRA–WIDE-FIELD SCANNING LASER OPHTHALMOSCOPY. Retina 2015; 35:1202-10. [DOI: 10.1097/iae.0000000000000463] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Swept source optical coherence tomography imaging of a series of choroidal tumours. Can J Ophthalmol 2015; 50:242-8. [DOI: 10.1016/j.jcjo.2015.02.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 01/14/2015] [Accepted: 02/01/2015] [Indexed: 11/23/2022]
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Abstract
UNLABELLED The prevalence of choroidal nevi (CN) ranges from 1% to 10%. It may be hard to differentiate a small melanoma from an atypical ("malignatized") CN, which occupies an intermediate position between typical nevi and actual melanomas and can be referred to as "progressive" or "suspicious". The risk of malignant transformation of a CN ranges from 0.78% to 7%, thus necessitating the need for a detailed description of its clinical features. OBJECTIVE To study clinical features of choroidal nevi in conjunction with their growth patterns. MATERIAL AND METHODS A total of 80 patients (84 eyes) with choroidal nevi were studied, including 23 men and 57 women aged 65.33±3.26 years on average. The follow-up period was 12-48 months. In 26 cases (30.95%) age-related macular degeneration (AMD) was also present. RESULTS Choroidal nevus is generally more common in women (71.25%). The right eye was involved in 36 cases, the left--in 48. Bilateral CN was diagnosed in 5% of cases. The follow-up period was 12-48 months. The nevi were mostly located in the juxtapapillary (11.9%) and macular (29.76%) regions. In 10 eyes they spread to the parafovea and foveola. The shape was typically round (73.8%), in the rest of cases--oval (26.2%). The size at presentation varied from 1 mm to 9 mm (2.93 mm on average). Diagnostic features of a stationary nevus (does not require a follow-up) have been identified. Nevus enlargement and changes in the overlying retina are indicative of progression. CONCLUSION On the basis of clinical presentation all choroidal nevi can be classified as either stationary or progressing. If progression is suspected, a close follow-up is required. Progressive destruction of the overlying retina and early signs of visual impairment are risk factors for melanoma development.
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Affiliation(s)
- A F Brovkina
- Russian Medical Academy of Postgraduate Education, Department of Ophthalmology, 2/1 Barrikadnaya St., Moscow, Russian Federation, 123995
| | - A S Stoyukhina
- Research Institute of Eye Diseases, 11 A,B, Rossolimo St., Moscow, Russian Federation, 119021
| | - Z S Popova
- Polyclinic No. 1 of the Administrative Department of the President of the Russian Federation, 26/28 Sivtsev Vrazhek pereulok, Moscow, Russian Federation, 119002
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Navajas EV, Costa RA, Calucci D, Hammoudi DS, Simpson ER, Altomare F. Multimodal fundus imaging in choroidal osteoma. Am J Ophthalmol 2012; 153:890-895.e3. [PMID: 22265155 DOI: 10.1016/j.ajo.2011.10.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Revised: 10/20/2011] [Accepted: 10/20/2011] [Indexed: 11/18/2022]
Abstract
PURPOSE To describe the morphologic features of calcified and decalcified choroidal osteomas using multimodal imaging and correlate these findings with a previous histopathologic study. DESIGN Retrospective observational case series. METHODS Three patients with choroidal osteoma underwent complete ophthalmologic examination, fundus photography, and multimodal fundus imaging, including Fourier-domain optical coherence tomography (FD-OCT) and blue-light fundus autofluorescence (bAF). RESULTS FD-OCT imaging of calcified tumors revealed a distinctive latticework pattern of reflectivity resembling the spongy bone structure seen histopathologically. On bAF the fluorescence was relatively well preserved overlying calcified tumors. In decalcified areas 2 patterns of reflectivity were identified: the first consisted of areas of relative hyperreflectivity with a lamellar appearance while the second was characterized by heterogeneous, hyperreflective, mound-like irregular areas associated with some posterior optical shadowing. Decalcified tumor areas had reduced overall fluorescence on bAF. CONCLUSION FD-OCT demonstrated different reflectivity patterns in both calcified and decalcified portions of the choroidal osteoma, which may correspond to different stages of tumor evolution. A distinctive latticework pattern of reflectivity similar to spongy bone was seen in calcified tumors. These observations improve our knowledge of the in vivo structure of choroidal osteomas and may have implications for the diagnosis and management of this tumor.
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Affiliation(s)
- Eduardo V Navajas
- Department of Ophthalmology and Vision Sciences, Princess Margaret Hospital, University of Toronto, Ontario, Canada.
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Materin MA, Raducu R, Bianciotto C, Shields CL. Fundus autofluorescence and optical coherence tomography findings in choroidal melanocytic lesions. Middle East Afr J Ophthalmol 2011; 17:201-6. [PMID: 20844674 PMCID: PMC2934710 DOI: 10.4103/0974-9233.65489] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: To establish the characteristics of secondary retinal and retinal pigment epithelial (RPE) changes associated with the presence of choroidal melanoma and choroidal nevus as documented by optical coherence tomography (OCT) and fundus autofluorescence (FAF). Materials and Methods: PubMed review of major English publications examining the correlation between clinical characteristics of choroidal melanoma and nevus with OCT and FAF findings. Results: The intrinsic properties of choroidal melanoma, as well as overlying RPE changes, drusen, and lipofuscin are best characterized by FAF, while OCT is more sensitive for the identification of subretinal and intraretinal fluid as well as atrophy, degeneration, and photoreceptor loss in the neurosensory retina. Conclusions: Secondary retinal changes associated with choroidal melanocytic lesions can be documented by OCT and FAF. OCT-evident changes are observed more often with choroidal melanoma than choroidal nevus. OCT is better suited to identify the overlying retinal detachment and edema, even before these findings are clinically apparent. FAF is most useful in documenting the presence of lipofuscin, a finding that represents one of the important criteria in differentiating small choroidal melanoma from benign choroidal nevus.
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Affiliation(s)
- Miguel A Materin
- Ophthalmic Oncology Section, Department of Ophthalmology, Yale University School of Medicine, New Haven, CT, USA
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Russell-Hermanns D, Fernandes B, PV S, Burnier Jr M. Eye growth transformation: uveal melanoma. EXPERT REVIEW OF OPHTHALMOLOGY 2010. [DOI: 10.1586/eop.10.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
PURPOSE The purpose of this study was to describe the autofluorescence (AF) features of choroidal hemangioma in 34 consecutive patients. METHODS Standard fundus photography and AF photography (580-nm excitation, 695-nm barrier filter) were performed on all patients. The clinical features were correlated with AF features. The main outcome measures were autofluorescence features of choroidal hemangioma (intrinsic AF) and overlying retinal pigment epithelium (extrinsic AF). RESULTS There were 27 eyes with circumscribed choroidal hemangioma (CCH) and 7 eyes with diffuse choroidal hemangioma (DCH). The mean patient age was 53 years for CCH and 15 years for DCH. Intrinsic AF of untreated CCH was generally iso-AF (n = 7, 58%) and for treated CCH was hypo-AF (n = 15, 100%). Extrinsic AF of CCH disclosed hyper-AF (orange pigment and fresh subretinal fluid) and hypo-AF (retinal pigment epithelium hyperplasia, fibrous metaplasia, and atrophy). Intrinsic AF of untreated DCH was generally hypo-AF (n = 2, 67%) and for treated DCH was hypo-AF (n = 3, 75%). Extrinsic AF of DCH was similar to CCH. CONCLUSION Choroidal hemangioma shows little intrinsic AF. Overlying orange pigment and fresh subretinal fluid show hyper-AF and retinal pigment epithelium hyperplasia and atrophy show hypo-AF.
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Abstract
PURPOSE To evaluate the fundus autofluorescence (FAF) patterns in the eyes with primary intraocular lymphomas (PIOLs). METHODS A review of the medical charts of four consecutive patients (five eyes) with PIOL who had been studied by FAF. A fundus camera was used to obtain the FAF images. Optical coherence tomography was also performed. RESULTS The ophthalmoscopically observed brown clumps on the surface of greasy yellowish masses beneath the retinal pigmented epithelium had a bright hyperfluorescence appearance by FAF. This FAF hyperfluorescence was completely reversed to hypofluorescence in the fluorescein angiograms. The diffuse infiltration of the cells making up the PIOL above the retinal pigmented epithelium was ophthalmoscopically observed as a retinal whitening and was hypofluorescent by FAF. These areas of hypofluorescence were also reversed to areas of hyperfluorescence in the fluorescein angiogram. Fundus autofluorescence clearly delineated the retinal pigmented epithelium atrophy, which developed after the spontaneous resolution of the PIOL as a hypoautofluorescent area. CONCLUSION Because FAF can reveal various findings of PIOLs, it can be used to differentiate the patients with PIOL from those with ocular inflammatory diseases. Although further studies are required to determine whether these findings are characteristic to PIOL, this noninvasive method can then lead to earlier diagnosis and treatment.
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Update on posterior uveal melanoma: treatment of the eye and emerging strategies in the prognosis and treatment of metastatic disease. Curr Opin Ophthalmol 2009; 20:504-10. [DOI: 10.1097/icu.0b013e328330b549] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Autofluorescence characteristics of suspicious choroidal nevi. ACTA ACUST UNITED AC 2009; 80:126-30. [DOI: 10.1016/j.optm.2008.07.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Revised: 07/10/2008] [Accepted: 07/29/2008] [Indexed: 02/03/2023]
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CORRELATION OF FUNDUS AUTOFLUORESCENCE WITH FLUORESCEIN AND INDOCYANINE GREEN ANGIOGRAPHY IN CHOROIDAL MELANOCYTIC LESIONS. Retina 2008; 28:1257-64. [DOI: 10.1097/iae.0b013e31817d5cdc] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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37
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