Ocular Oncology

Case 3

Patient Presentation: An 88-year-old female was referred to the ocular oncology service to “rule out neoplasm.” The patient symptomatically noted decreased vision in her right eye for 1 month. Her past ocular history included retinal detachment repair OD 15 years ago, primary open angle glaucoma controlled with topical agents, and dry age-related macular degeneration changes for the past 2 years. Vision was 20/50 OD and 20/25 OS with normal IOP and pupillary examination. Optos widefield fundus photos are shown below. Notably, a laser scar was appreciated in the far temporal periphery OD, along with a suspicious, well-demarcated, dark, circular lesion in the mid-far periphery at 10 o’clock. 

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Fundus autofluorescence OD and bilateral OCTs of the macula were conducted and shown below:

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

A B-scan ultrasound with corresponding A-scan was completed over the lesion in the periphery and shown below, which demonstrated a lesion with a hyperechoic surface and hypoechoic core. This hypoechogenicity, if looking at the corresponding A-scan, produces a low signal similar to the level of the vitreous.

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An OCT over the lesion was performed and showed below:

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Question: What finding is not seen in the above OCT of the lesion?

Question: Based on fundus photo, FAF, ultrasound and OCT of the lesion, what is the most likely diagnosis?

Question: Which of the following diseases have been postulated to be a variant or causative entity of PEHCR?

Question: What treatment is typically indicated for asymptomatic PEHCR?

Learning Objectives:

  1. To understand the OCT features, fundus findings and ultrasound characteristics of peripheral exudative hemorrhagic chorioretinopathy.

  2. To differentiate PEHCR from choroidal melanoma.

  3. Associations and treatments of PEHCR.