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Choroidal nevus and chrpe
- 2. Nevus – COMS def. - <= 5mm basal diameter <= 1 mm height – Freckle - visible, normal choroidal vessels passing undisturbed through
- 3. Pathology – Plumper melanocytes – Involves entire thickness of choroid with sparing of choriocapillaries – Pigmentation vary – polyhedral, fusiform, dendritic, spindle, balloon – Calender’s classification - composed entirely of – spindle A cells – Spindle B cells
- 4. Clinical features – Asymptomatic – RPE atrophy
- 5. – chronic foveal edema, and persistent subretinal fluid - photoreceptor atrophy – metamorphopsia or photopsia
- 6. PED
- 7. – Drusen – sign of chronicity
- 8. – Choroidal neovascularization - sign of chronicity
- 9. Clinical Variants – Halo Nevus
- 11. – Amelanotic Nevus ? choroidal metastases, ? Choroidal hemangioma or ? inflammatory granuloma
- 12. Risk Factors for Malignant Transformation – freckles - not known to undergo malignant transformation – CNV – not indicative of malignancy – Thickness > 2 mm – Orange pigment – Margin touching disc – Visual symptoms – Sub retinal fluid – Orange pigment
- 13. Diagnostic Evaluation – Fundus photography, – oct – fluorescein angiography, – autofluorescence imaging, – Ultrasonography – fine-needle aspiration biopsy
- 14. EDI - OCT – Amelanotic nevi - homogenous with a medium reflective band and visible choroidal vessels – Melanocytic nevi - highly reflective band within the choriocapillaris layer with posterior shadowing
- 15. ICG – Might be malignant
- 16. Differential Diagnosis – Reactive retinal pigment epithelial hyperplasia – Congenital hypertrophy of the retinal pigment epithelium
- 17. CHRPE – divided into solitary and multifocal variants, - also known as congenital grouped pigmentation or “bear tracks.” – unlike choroidal nevus and melanoma, no predilection for race. – not associated with an increased incidence of FAP or gastrointestinal malignancy
- 18. Solitary CHRPE – Pigmented (88%) / depigmented – Only 2% are macular or peripapillary – Lacunae - depigmented foci – depigmented ring or “halo”
- 19. – FFA – blocked fluorescence – AF – hypoautofluorescence – USG – nondiagnostic – 0.5 to 1 mm thickness – Oct - retinal thinning, loss of photoreceptors, and moderate shadowing of the underlying choroid
- 20. Management – periodic observation – nodular growth - exudation or subretinal fluid - photocoagulation or cryotherapy – Macular lesion - surface wrinkling retinopathy
- 21. Mlultifocal CHRPE – groups of well-delineated, flat, slate gray lesions - usually sectoral distribution – Each individual lesion is similar to unifocal CHRPE, but is usually smaller and does not show the lacunae or haloes of depigmentation
- 22. – Nonpigmented - “polar bear tracks,”
- 23. – a close relationship has been recognized with FAP and Gardner syndrome familial colonic cancer – fundus lesions have been called CHRPE, but they are actually different from they are bilateral, more haphazard distribution, more irregular borders