Date of Award

January 2020

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Lucian Del Priore

Second Advisor

Jay S. Duker

Abstract

SWEPT SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IN CHOROIDAL MELANOMAS AND CHOROIDAL NEVI

Eugenia Custo Greig, Nora V. Laver, Luisa S.M. Mendonca, Emily S. Levine, Caroline R. Baumal, Nadia K. Waheed, and Jay S. Duker, Department of Ophthalmology, New England Eye Center, Tufts University, Boston, MA. (Sponsored by Lucian Del Priore, Department of Ophthalmology, Yale University, School of Medicine).

This study evaluated the use of swept source optical coherence tomography angiography (SS-OCTA) to detect distinct vascular features in small choroidal melanomas and choroidal nevi. Patients with a choroidal nevus or a small treatment-naïve choroidal melanoma were imaged with color fundus photography, ultrasound and SS-OCTA (12x12mm). High-risk features including overlying fluid, orange pigment, shaggy photoreceptors, acoustic hollowness, depth >2mm, and basal diameter >5mm were assessed. OCTA vascular markers included: choroidal vessel visualization and depth, as well as choriocapillaris (CC) flow signal, assessed qualitatively by comparison to surrounding, unaffected CC. Twenty-nine lesions were included in this study, 7 flat choroidal nevi, 17 elevated choroidal nevi and 5 choroidal melanomas. Choroidal nevi displayed straight, parallel vessels on imaging. Two types of choroidal melanomas were identified. The first group had “nevus-like” vasculature and the second group had complex vasculature with vascular loops and cross-linking. Visualized choroidal vessels were deeper in melanomas than elevated nevi or flat nevi (p = 0.009). In a size-matched sub-analysis of 5 elevated choroidal nevi and 5 choroidal melanomas, choroidal melanomas had increased mean choroidal vessel depth (p = 0.015), increased depth of deepest choroidal vessel visualized (p = 0.034), and higher likelihood of presence of a deep choroidal vessel >155um (p = 0.048). SS-OCTA may detect distinct vascular features in choroidal nevi and small choroidal melanomas that could aid in lesion differentiation.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

Download

Share

COinS