Ocular Oncology

Case 5

Patient Presentation: A 74-year-old male was referred to an ocular oncology clinic for assessment of a suspicious pigmented choroidal lesion OS found on a routine eye examination. The patient denied any past medical or ocular history. He denied change in vision or visual symptoms. His vision was 20/25 OD and 20/20 OS with pressures within normal limits. Anterior segment examination was unremarkable. Fundus photos OS were performed and are shown below:

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Question: What additional finding is appreciated on the OS fundus photos? 

A 5-line raster OCT was conducted over the lesion in question, and is shown below:

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Question: What is the most likely diagnosis?

When examining the OCT macula, you note that there was suspicious sub-RPE hyper-reflective material, shown by the red arrow below.

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This fibrovascular PED was further characterized by an OCT angiography, which is shown below:

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Question: What complication of choroidal nevi is demonstrated by the OCTA?

Question: What treatment would be used to manage the CNV associated with the choroidal nevus?

Learning Objectives:

  1. Features favouring a diagnosis of a choroidal nevus in comparison to choroidal melanoma

  2. Diagnosis and treatment of CNV complication of choroidal nevus