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[Choroidal melanoma and retinal changes].

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Optical coherence tomography (OCT) can detect retinoinvasive choroidal melanoma (CM) spreading into the retina. This finding is crucial for treatment planning, especially for local resection and brachytherapy.

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Area of Science:

  • Ophthalmology
  • Oncology
  • Medical Imaging

Background:

  • Choroidal melanoma (CM) is a rare intraocular malignancy.
  • Literary sources suggest a retinoinvasive phenotype of CM, but factual evidence is limited.

Purpose of the Study:

  • To evaluate the capabilities of optical coherence tomography (OCT) in identifying choroidal melanoma invasion into the retina.
  • To correlate OCT findings with pathomorphological examination of enucleated eyes.

Main Methods:

  • OCT imaging of 64 eyes with CM.
  • Pathomorphological analysis of 18 eyes with CM, focusing on invasion patterns.

Main Results:

  • OCT detected retinal invasion in 49 eyes, with signs including tumor aggregation and Bruch's membrane/retinal pigment epithelium disruption.
  • Pathomorphology confirmed CM invasion in 13 eyes, often starting with Bruch's membrane destruction and affecting retinal layers.
  • Large CMs showed extensive Bruch's membrane destruction and invasion into edematous retina and vitreous.

Conclusions:

  • OCT is valuable for assessing retinal integrity in CM, even for thinner tumors.
  • Retinal invasion and proximity to the optic disc are contraindications for local endovitreal resection.
  • Tumor characteristics and retinal thickness are critical for brachytherapy dose calculation.