PMC4358416_01
Fundus color image, fluorescein angiography and optical coherence tomography findings in patient's right eye at initial examination.. Notes: (A) Color image of the right eye fundus at first consultation, showing a deep black melanocytoma (arrow) occupying the inferotemporal half of the optic disk extending temporally to the adjacent retina (note the striated margins) and apparently to the inferior juxtapapillary choroid; subretinal choroidal neovascular complex (arrowhead) near the superotemporal margin of the optic disk, with multiple fine subretinal folds radiating from it, and two retinal folds crossing horizontally through the central macula; a myriad of fine reflective subretinal lipid deposits under the macula and nasal half of the posterior pole extending beyond the temporal vascular arcades and densely concentrated subretinal lipids at the inferior margin of the optic disk; and moderate optic disk edema and dilatation and tortuosity of superior temporal and nasal retinal veins. (B) Early arteriovenous phase fluorescein angiogram showing evident epipapillar and peripapillar retinal capillary telangiectasia, extending four-disk diameters superotemporally at both sides of the superotemporal retinal vein (arrows). (C) Venous phase fluorescein angiogram of the same eye, showing leakage from the choroidal neovascular complex (arrows) and from telangiectatic retinal capillaries of the superior juxtapapillar area (arrowheads). (D) Time domain optical coherence tomography scan passing through the fovea and choroidal neovascular complex in the same eye (arrowheads), showing shallow neurosensory detachment (arrows) and intraretinal edema in the superonasal quadrant of the macula.
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In addition, a moderate optic disk edema and superior temporal and nasal retinal venous ingurgitation and tortuosity was observed (Figure 1A). Fluorescein angiography confirmed the presumption of an active CNV complex (Figure 1B), with staining of the subretinal fluid around the optic disk in the very late angiographic phases.
Post treatment fundus color image, fluorescein angiography and optical coherence tomography findings.. Notes: (A) Color image of the right eye fundus of the same patient 3 years after treatment showing complete resolution of subretinal fluid, lipid deposits and hemorrhage, and a fibrotic scar at the level of the choroidal neovascular complex; an apparent subretinal extension from the superotemporal margin of the tumor extends as a tongue toward the choroidal neovascular scar; inframacular and infrapapillar subretinal punctuate pigment dispersion is also observed, and adjacent choroidal component melanocytoma is now visible at the inferior margin of the optic disk. (B) Venous phase of fluorescein angiogram showing impregnation of choroidal neovascular scar and no capillary telangiectasia and juxtapapillar and optic disk leakage. (C) Spectral domain optical coherence tomography scan passing through the macula showing complete resolution of subretinal fluid and macular edema. (D) Spectral domain optical coherence tomography scan passing through choroidal neovascular scar.
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After 3 years of follow-up, BCVA remained stable; the right eye fundus showed a normal macular area, no evident optic nerve edema, normal retinal vein caliber and aspect, and no significant change of the tumor; the choroidal part of the tumor and the subretinal pigment dispersal were better visualized (Figure 2A). Fluorescein angiography evidenced only late staining without leakage of the CNV complex, no macular edema, and no evident capillary telangiectasia (Figure 2B). Spectral domain OCT (Cirrus ; Carl Zeiss Meditec, Dublin, CA, USA) showed a normal macular anatomy (Figure 2C), with a well-delineated domo-shaped homogeneous hyperreflective image at the level of the juxtapapillary CNV complex (Figure 2D).