Ocular Oncology

Case 4

Patient Presentation: A 64-year-old Caucasian female was referred to an ocular oncology clinic for a suspicious fundus lesion detected 3-weeks prior by an optometrist, as well as blurred vision OS. The patient’s past medical history included excision of a cervical pre-cancerous lesion.

Her best-corrected distance visual acuity was 20/20 OD and 20/30 OS with pressures within normal limits. Anterior segment and fundus examination was unremarkable, except for the amelanotic choroidal lesion demonstrated by the fundus photo, optos widefield and fundus autofluorescence images below:

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Question: What tests are crucial in aiding in the diagnosis of this lesion?

A B-Scan ultrasound, with corresponding A-Scan, was completed and is shown below:

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The B-Scan over the lesion demonstrates acoustic solidity, whereas the A-Scan notes medium -high reflectivity throughout the tumour thickness.

An OCT over the lesion was conducted and is shown below:

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Question: What feature is NOT present in the OCT above?

Fluorescein angiography is shown of a lesion with the same diagnosis, which demonstrates progressive fluorescence and late homogenous staining below:

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Question: Based on the above imaging, what is the most likely diagnosis?

Question: What is the treatment for choroidal hemangioma?

Learning Objectives:

  1. Describe the OCT and multimodal imaging features of choroidal hemangiomas.

  2. Differentiate choroidal hemangiomas from melanomas and lymphomas.