Optical coherence tomography in the differential diagnosis of residual melanoma and pigment epithelial hyperplasia after transpupillary thermotherap

    Abstract

    Optical coherence tomography in the differential diagnosis of residual melanoma and pigment epithelial hyperplasia after transpupillary thermotherapy

    Stoyukhina A.S., Brovkina A.F.

    Department of retina and optic nerve pathology, Research Institute of Eye Diseases
Department of ophthalmology, Russian Medical Academy of Postgraduate Education of Ministry of health of the Russian Federation

    Purpose. To identify differential diagnostic criteria for RPE hyperplasia and continued tumor growth in the scar zone after transpupillary thermotherapy (TTT) by the use of OCT.

    Material and methods. The results of OCT performed in 18.25±13.38 months after the end of TTT treatment of choroid melanoma (CM) in 4 patients. The age at the time of OCT is 57–76 years (68.75±4.17), the ultrasound focus elevation was from 0 to 1.54 mm.

    Results. OCT signs of the presence of a chorioretinal scar (3 eyes) are flat chorioretinal profile with a significant increase in the optical density of the choroid, a decrease in thickness until it disappears completely and a significant thinning of the overlying retina. Insufficient CM response to treatment (1 eye) – elevation of the chorioretinal profile with an uneven surface and uneven hyperreflective structure of the choroid; along the edges of the focus, zones of the altered choriocapillary layer and visual disturbances in Bruch's membrane; overlying retina of uneven thickness, with a strong vitreoretinal traction in the lower parts of the focus. In the area of an intensely pigmented area surrounded by a scar (2 eyes), was an elevation of the chorioretinal complex with a significant thinning of the retina and its intensely hyperreflective structure, which blocking of signal from the underlying tissues. The residual CM in the scar (1 eye) is an elevation of the tomographic section with an uneven surface and is moderate hyperreflective structure of the inner surface of the choroidal complex with deposits at the retinal pigment epithelium RPE level and intraretinal cavities.

    Conclusion. The differential diagnostic criterion of reactive retinal pigment epithelium hyperplasia after organ-preserving treatment of choroidal melanoma should be recognized as an elevation of the tomographic section in the zone of interest with an intense hyperreflective structure of the altered retina and blocking the signal from the underlying tissues. Residual tumor is characterized by elevation of the tomographic section with an moderately hyperreflective structure of the altered choroid and secondary changes in the proper retina.

    Key words: choroidal melanoma, optical coherent tomography, transpupillary thermotherapy, residual tumor in a scar, reactive retinal pigment epithelium hyperplasia.