MULTIMODAL IMAGING IN BILATERAL ISOLATED CHOROIDAL MELANOCYTOSIS

To report a rare case of bilateral isolated choroidal melanocytosis and highlight the need for thorough imaging evaluation.

Multimodal imaging, including ultra-widefield fundus photography, fundus autofluorescence, optical coherence tomography, and optical coherence tomography angiography, was used to assess the findings.

A 58-year-old Hispanic woman was referred for evaluation of unusual pigmentation in both eyes. She reported occasional floaters but had no other ocular symptoms. Dilated fundus examination and ultra-widefield color fundus imaging revealed extensive choroidal hyperpigmentation involving 360° of the peripheral retina in both eyes. Fundus autofluorescence imaging demonstrated that the hyperpigmented regions were mildly hypofluorescent relative to the less pigmented central regions. Widefield optical coherence tomography angiography demonstrated absence of any vascular abnormalities in the retina or inner choroid. Widefield structural optical coherence tomography revealed normal retinal thickness and structure overlying the hyperpigmented areas. There was no choroidal elevation, but the choroidal stroma in the more peripheral regions of the fundus seemed more hyperreflective than the presumed normally pigmented central regions. Although no choroidal elevation was noted, there was a mild increase in subfoveal choroidal thickness. No evidence of scleral or periocular cutaneous pigmentation was observed. The overall findings, considering the patient's ethnicity and skin pigmentation, favored a diagnosis of bilateral idiopathic choroidal melanocytosis.

Bilateral isolated choroidal melanocytosis can be diagnosed accurately through comprehensive imaging. Vigilant monitoring is essential because of the potential risk of malignant transformation.