1) A 42-year-old woman was found to have an elevated black-brown mass on her left optic disc during a routine eye exam. 2) B-scan ultrasound found an iso-echoic, elevated lesion over the optic nerve head with no internal reflectivity. 3) Over two years of follow-up the lesion increased slightly in size but the patient's vision remained stable at 6/6. 4) Infrared and infrared autofluorescence imaging helped determine the growth and activity of the optic disc melanocytoma by showing features of the lesion and a region of new growth.

1. Optic Disc
Melanocytoma
Dr Pavan Shroff
Fellow – Vitreous-Retina Department,
M.M. Joshi Eye Institute.

2. Case History
• 42 years old lady visits OPD for a routine check-up.
• No h/o systemic illness.
• RE BCVA: 6/6
• LE BCVA: 6/6

3. • Anterior Segment: Appears normal.
• Pupils: Reacting
• RE: Pseudophakia
• LE: Early Nuclear Sclerosis
• Fundus Examination:
• RE: Normal
• LE: Elevated, black-brown mass at the disc.
Rest appears normal.

4. • Anterior Segment: Appears normal.
• Pupils: Reacting
• RE: Pseudophakia
• LE: Early Nuclear Sclerosis
• Fundus Examination:
• RE: Normal
• LE: Elevated, black-brown mass at the disc.
Rest appears normal.

5. B-Scan:
• Iso-echoic, elevated lesion over optic nerve head.
• No internal reflectivity was seen.

6. • Patient was followed up for 2 years
• Maintains BCVA 6/6 in BE.
• RE Fundus: Normal
• LE Fundus:
• Mild increase in the size of the lesion.
• Rest appears normal.

7. Fundus Photographs
May 2015 October 2017

8. Short Wave Autofluorescence
• Hypo-autofluorescence: The lesion
along with the optic disc

9. Multicolor Imaging
• Lesion appears as bright red, not
uniform throughout the lesion.

10. SD-OCT
• Hyper-reflective inner layers of the
lesion.
• Abrupt posterior optical
shadowing.

11. SD-OCT
• Noteworthy that:
• Hyper-reflecting dots scattered over
the inner (towards vitreous) part of
the lesion.
• These dots correspond to the region
of new growth.

12. Infrared Imaging
• Hyper-reflectance with well defined
outline
• Region of new growth of the
Melanocytoma: Relative Hypo-
reflectance

13. Infrared Autofluorescence Imaging
• The lesion shows hyper-
autofluorescence, though not
uniform
• The relative hyper-autofluorescent
part of the lesion is surrounded by
a more hyperfluorescent arc
temporally.

14. • Thus Infrared and IR-AF imaging helps determining the growth and activity
of Optic Disc Melanocytoma.
• Morphological features of the lesion can be better studied.

15. Management
• Majority of cases will maintain good vision
• Less association with complications
• 2-3% will show malignant transformation
• Thickness of >1.5 mm: associated with poor prognosis

16. • Follow-up the patient yearly.
• Minimal increase in lesion does not indicate malignant transformation
• Diminution of Vision with significant increase in lesion-> Malignancy
• Enucleation may be needed in case of malignancy.

17. Message
• Infrared autofluorescence is based on the melanin content of the tissue and
that can be helpful in studying the activity of various lesions.