Shields Carol L, Arepalli Sruthi, Pellegrini Marco, Mashayekhi Arman, Shields Jerry A
*Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania; and †Eye Clinic, Department of Biomedical and Clinical Science "Luigi Sacco", Luigi Sacco Hospital, University of Milan, Milan, Italy.
Retina. 2014 Jul;34(7):1347-53. doi: 10.1097/IAE.0000000000000145.
To describe the features of choroidal lymphoma on enhanced depth imaging optical coherence tomography.
This retrospective observational case series included 14 eyes of 13 patients, with choroidal lymphoma, studied by enhanced depth imaging optical coherence tomography.
The mean age at presentation was 63 years (median, 65 years; range, 32-87 years). Systemic lymphoproliferative disease was present in 2 cases as non-Hodgkin lymphoma (n = 1) or Waldenstrom macroglobulinemia (n = 1). On clinical examination, the choroidal infiltrate was classified as unifocal (n = 3), multifocal (n = 4), or diffuse (n = 7). Enhanced depth imaging optical coherence tomography scans through the tumor epicenter revealed infiltration of the choroid with apparent inward compression of choroidal vascular structures, creating an anterior tumor surface topography that appeared smooth (calm) (n = 7), mini-wavy (rippled) (n = 2), or maxi-wavy (undulating) (n = 5). Greater tumor thickness correlated with increasing tumor surface fluctuation as calm was mean 1.7mm, rippled was 2.8 mm, and undulating surface was 4.1 mm in ultrasonographic thickness. On enhanced depth imaging optical coherence tomography, the mean subfoveolar choroidal thickness, measurable in 9 eyes, was 484 μm (median, 423 μm; range, 156-1,002 μm) (81% greater) versus 267 μm (median, 276 μm; range, 142-501 μm) in the unaffected eye. The mean maximal tumor thickness, measurable in 8 eyes, was 117% greater at 602 μm (median, 538 μm; range, 241-966 μm) compared with the corresponding unaffected choroid in the contralateral eye at 278 μm (median, 245 μm; range, 189-511 μm) (P = 0.046). Inability to measure choroidal thickness was due to dense tumor-induced optical shadowing with inability to visualize the sclerochoroidal junction (P = 0.009). There was no visible infiltration into the overlying retina in any case.
Enhanced depth imaging optical coherence tomography of choroidal lymphoma revealed 1 of 3 surface topographical patterns resembling an ocean as calm (n = 7), rippled (n = 2), or undulating (n = 5), correlating with increasing tumor thickness.
描述脉络膜淋巴瘤在增强深度成像光学相干断层扫描中的特征。
本回顾性观察病例系列纳入了13例患者的14只患有脉络膜淋巴瘤的眼睛，采用增强深度成像光学相干断层扫描进行研究。
就诊时的平均年龄为63岁（中位数为65岁；范围为32 - 87岁）。2例患者存在全身性淋巴增殖性疾病，分别为非霍奇金淋巴瘤（1例）或华氏巨球蛋白血症（1例）。临床检查时，脉络膜浸润被分类为单灶性（3例）、多灶性（4例）或弥漫性（7例）。通过肿瘤中心的增强深度成像光学相干断层扫描显示脉络膜浸润，脉络膜血管结构明显向内受压，形成的肿瘤前表面形态呈光滑（平静）（7例）、微波浪状（波纹状）（2例）或大波浪状（起伏状）（5例）。肿瘤厚度越大，肿瘤表面波动越大，超声测量厚度方面，平静表面平均为1.7mm，波纹状为2.8mm，起伏表面为4.1mm。在增强深度成像光学相干断层扫描中，9只眼睛可测量的黄斑下脉络膜平均厚度为484μm（中位数为423μm；范围为156 - 1002μm）（比健眼厚81%），而健眼为267μm（中位数为276μm；范围为142 - 501μm）。8只眼睛可测量的肿瘤最大平均厚度为602μm（中位数为538μm；范围为241 - 966μm），比健眼相应的脉络膜厚度（对侧眼为278μm，中位数为245μm；范围为189 - 511μm）厚117%（P = 0.046）。无法测量脉络膜厚度是由于肿瘤导致的密集光学阴影，无法观察到巩膜脉络膜交界处（P = 0.009）。所有病例中均未观察到视网膜有明显浸润。
脉络膜淋巴瘤的增强深度成像光学相干断层扫描显示出三种表面形态模式之一，类似于海洋般平静（7例）、波纹状（2例）或起伏状（5例），且与肿瘤厚度增加相关。
