Choroidal neovascularization related to melanocytic naevus – a single centre study Original research study
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Purpose: To assess the angiographic and optical coherence tomography angiography (OCTA) features as well as the natural course of the choroidal neovascularization (CNV) associated with choroidal naevi.
Setting/venue: Ocular Oncology Service, Department of Ophthalmology, Poznan University of Medical Sciences.
Material and methods: Retrospective chart analysis of the patients who presented to the Ocular Oncology Service in Poznan, Poland between 2011–2021 with the diagnosis of suspicious choroidal naevus. In all patients full ophthalmic examination and multimodal imaging, including fundus photography, autofluorescence, B-ultrasound, optical coherence tomography (OCT), OCT angiography (OCTA) and fluorescein angiography (FAF), were performed.
Results: There were 9 lesions in 9 patients, 9 women aged 14–79 years (mean age: 58.2 years). All the lesions were located in the posterior pole and most of them were pigmented (88.9%). CNVs associated with choroidal naevi were type I in 66.7% and type II in 33.3% of cases. 5 patients required treatment: anti-VEGF injection (alone or with transpupillary thermotherapy) was administered. The median follow-up was 24 months (range: 2–145). In two of all treated patients (40%), we observed BCVA gain (2–4 lines), in one patient (20%) it remained stable and in two (40%) it deteriorated. The final visual acuity was below 0.1 only in 1 patient. During the period of observation none of the lesions progressed to uveal melanoma.
Conclusions: CNV associated with choroidal naevus could be the reason for subretinal fluid (SRF) leakage and visual loss. The response to anti-VEGF treatment is satisfactory in the majority of patients. Choroidal naevi with accompanying CNV have none or very low malignant transformation potential.
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2. Shields CL, Lally SE, Dalvin LA et al. White paper on ophthalmic imaging for choroidal nevus identification and transformation into Melanoma. 2021; 10(2): 1-10.
3. Kivelä T, Eskelin S. Transformation of Nevus to Melanoma. Ophthalmology. 2006; 113(5): 887-888.e1.
4. Shields CL, Shields JA, Kiratli H et al. Risk Factors for Growth and Metastasis of Small Choroidal Melanocytic Lesions. Ophthalmology. 1995; 102(9): 1351-61.
5. Shields CL, Dalvin LA, Ancona-Lezama D et al. Choroidal nevus imaging features in 3,806 cases and risk factors for transformation into melanoma in 2,355 cases. 2019; 39: 1840-51.
6. Fung AT, Guan R, Forlani V et al. Subclinical subretinal fluid detectable only by optical coherence tomography in choroidal naevi – the SON study. Eye. 2021; 35(7): 2038-44.
7. Naumann G, Hellner K, Naumann L et al. Pigmented nevi of the choroid: clinical study of secondary changes in the overlying tissues. Trans Am Acad Ophthalmol Otolaryngol. 1971; 75: 110-23.
8. Gass J. Problems in the differential diagnosis of choroidal nevi and malignant melanoma. XXXIII Edward Jackson Memorial lecture. Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol. 1977; 83(1): 19-48.
9. Callanan DG, Lewis ML, Byrne SF et al. Choroidal Neovascularization Associated With Choroidal Nevi. Arch Ophthalmol. 1993; 111(6): 789-94.
10. Papastefanou VP, Nogueira V, Hay G et al. Choroidal naevi complicated by choroidal neovascular membrane and outer retinal tubulation. Br J Ophthalmol. 2013; 97(8): 1014-9.
11. Kanski JJ. Clinical ophthalmology: a systematic approach. 5 ed. Edinburgh: Butterworth-Heinemann; 2003.
12. Munie MT, Demirci H. Management of Choroidal Neovascular Membranes Associated with Choroidal Nevi. Ophthalmol Retina. 2018; 2(1): 53-8.
13. Pellegrini M, Corvi F, Say EAT et al. Optical coherence tomography angiography features of choroidal neovascularization associated with choroidal nevus. Retina. 2018; 38(7): 1338-46.
14. Chiang A, Bianciotto C, Maguire JI et al. Intravitreal bevacizumab for choroidal neovascularization associated with choroidal nevus. Retina. 2012; 32(1): 60-7.
15. Zografos L, Mantel I, Schalenbourg A. Subretinal Choroidal Neovascularization Associated with Choroidal Nevus. Eur J Ophthalmol. 2004; 14(2): 123-31.
16. Zidlik V, Brychtova S, Uvirova M et al. The Changes of Angiogenesis and Immune Cell Infiltration in the Intra- and Peri-Tumoral Melanoma Microenvironment. Int J Mol Sci. 2015; 16(12): 7876-89.
17. Yu MD, Dalvin LA, Ancona-Lezama D et al. Choriocapillaris Compression Correlates with Choroidal Nevus Associated Subretinal Fluid: OCT Analysis of 3431 Cases. Ophthalmology. 2020; 127(9): 1273-6.
18. Cennamo G, Montorio D, Fossataro F et al. Optical coherence tomography angiography in quiescent choroidal neovascularization associated with choroidal nevus: 5 years follow-up. Eur J Ophthalmol. 2021; 31(5): NP111-5.
19. Folk JC, Weingeist TA, Coonan P et al. The Treatment of Serous Macular Detachment Secondary Choroidal Melanomas and Nevi. Ophthalmology. 1989; 96(4): 547-51.
20. Parodi MB. Transpupillary thermotherapy for subfoveal choroidal neovascularization associated with choroidal nevus. Am J Ophthalmol. 2004; 138(6): 1074-5.
21. Caminal JM, Mejia-Castillo KA, Arias L et al. Subthreshold transpupillary thermotherapy in management of foveal subretinal fluid in small pigmented choroidal lesions. Retina. 2013; 33(1): 194-9.
22. García-Arumí J, Amselem L, Gunduz K et al. Photodynamic therapy for symptomatic subretinal fluid related to choroidal nevus. Retina. 2012; 32(5): 936-41.
23. Pointdujour-Lim R, Mashayekhi A, Shields JA et al. Photodynamic therapy for choroidal nevus with subfoveal fluid. Retina. 2017; 37(4): 718-23.
24. Stanescu D, Wattenberg S, Cohen SY. Photodynamic therapy for choroidal neovascularization secondary to choroidal nevus. Am J Ophthalmol. 2003; 136(3): 575-6.