Ocular Oncology

Case 1

Patient Presentation: A 53-year-old asymptomatic female was referred to the ocular oncology service to rule out melanocytoma in the left eye. No past medical or ocular history was noted. Review of systems was unremarkable. Vision was 20/20 OU with normal IOP and anterior segment examination. Fundus examination of the right eye was normal. Fundus examination of the left eye revealed the following:

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You pull up a fundus photo and FAF of known melanocytoma that you saw earlier in your training for reference, which is shown below. Note the more prominent encroachment of the feathery lesion into the optic nerve head, with no red hue around the melanocytoma.

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To help further characterize the lesion and associated hemorrhage, an OCT of the optic nerve OS was conducted and shown below: 

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Question: What finding is not appreciated in this OCT optic nerve above?

Your colleague shares an OCT of an optic nerve with known melanocytoma for your reference:

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Question: What is the biggest difference in the known melanocytoma OCT above compared to the OCT of our patient presentation?

Question: Which of the following OCT findings is NOT usually seen in melanocytomas? 

Back to our patient presentation, a flow B-scan OCT angiography with corresponding en-face OCT of the outer retina/choriocapillaris layer is shown below:

Question: What is the most striking finding in the OCT angiography above?

Question: What is the treatment for this specific asymptomatic patient?

Learning Objectives:

1.    To understand the OCT and OCT angiography features juxtapapillary CNVM.
2.    To differentiate juxtapapillary CNVM from optic nerve melanocytoma.