Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
Ophthalmol Retina. 2023 Feb;7(2):171-177. doi: 10.1016/j.oret.2022.08.013. Epub 2022 Aug 13.
To determine the clinical features and outcomes of choroidal melanoma initially masquerading as central serous chorioretinopathy (CSCR).
Retrospective case series.
All patients with choroidal melanoma, initially misdiagnosed as CSCR elsewhere and evaluated by the Ocular Oncology Service at Wills Eye Hospital from 2004 to 2022, were included.
A retrospective detailed review of patient charts and imaging was performed for all patients included in the study. Paired t tests and chi-squared tests were performed for data analysis.
The primary outcome measures included clinical characteristics, ultrasonography, OCT, fundus autofluorescence, fluorescein angiography, and indocyanine green angiography. The secondary outcome measures included treatment results, such as the final visual acuity, tumor control, radiation-related complications, and melanoma-related metastlasis and death.
There were 22 patients (mean age, 48 years; 16 men) in this cohort. The mean interval between initial CSCR diagnosis and suspicion of choroidal melanoma was 50 months (median, 50 months; range, 0-242 months). At tumor diagnosis, the melanoma was submacular in 16 (73%) patients and extramacular in 6 (27%) patients. The mean tumor thickness was 3.4 mm (median, 2.5 mm; range, 1.4-10.7 mm), and the mean basal diameter was 9.2 mm (median, 8.0 mm, range, 4.5-22.0 mm). Features enabling differentiation of choroidal melanoma from CSCR (affected versus unaffected eye) included choroidal thickness asymmetry (100% > 300 μm versus 21% > 300 μm; P = 0.005), ipsilateral choroidal surface irregularity (100% versus 0%; P < 0.001), loss of choroidal vascular detail on OCT (100% versus 0%; P < 0.001), presence of multiple pinpoint leaks on angiography (100% versus 0%; P < 0.001), and contralateral lack of autofluoresence abnormalities (75% versus 6%; P = 0.001). Management of the choroidal melanoma included plaque radiotherapy (19, 86%), enucleation (2, 9%), or treatment elsewhere (1, 5%). On follow-up (mean, 6 years), vision loss of ≥ 3 Snellen lines (9 patients, 47%), metastasis (3 patients, 14%), and death (1 patient, 5%) were noted.
Patients with presumed CSCR, especially if chronic, should be evaluated for a possible thin underlying choroidal melanoma with a dilated fundus examination and multimodal imaging.
确定最初表现为中心性浆液性脉络膜视网膜病变（CSCR）的脉络膜黑色素瘤的临床特征和结局。
回顾性病例系列。
所有在 2004 年至 2022 年期间在威尔斯眼医院眼科肿瘤服务处被误诊为 CSCR 并接受评估的脉络膜黑色素瘤患者。
对所有纳入研究的患者的病历和影像学资料进行回顾性详细分析。数据分析采用配对 t 检验和卡方检验。
主要观察指标包括临床特征、超声检查、OCT、眼底自发荧光、荧光素血管造影和吲哚青绿血管造影。次要观察指标包括治疗结果，如最终视力、肿瘤控制、放射相关并发症以及黑色素瘤相关转移和死亡。
该队列中有 22 名患者（平均年龄 48 岁；16 名男性）。初次 CSCR 诊断与怀疑脉络膜黑色素瘤之间的平均间隔时间为 50 个月（中位数 50 个月；范围 0-242 个月）。在肿瘤诊断时，16 名（73%）患者的黑色素瘤位于黄斑下，6 名（27%）患者位于黄斑外。平均肿瘤厚度为 3.4 毫米（中位数 2.5 毫米；范围 1.4-10.7 毫米），平均基底直径为 9.2 毫米（中位数 8.0 毫米，范围 4.5-22.0 毫米）。能够将脉络膜黑色素瘤与 CSCR 区分开来的特征（受累眼与未受累眼）包括脉络膜厚度不对称（100% > 300 μm 与 21% > 300 μm；P=0.005）、同侧脉络膜表面不规则（100% 与 0%；P<0.001）、OCT 上脉络膜血管细节丢失（100% 与 0%；P<0.001）、造影上存在多个针尖状渗漏（100% 与 0%；P<0.001）和对侧无自发荧光异常（75% 与 6%；P=0.001）。脉络膜黑色素瘤的治疗包括斑块放疗（19 例，86%）、眼球摘除术（2 例，9%）或其他地方治疗（1 例，5%）。在随访（平均 6 年）期间，有 9 名患者（47%）视力下降≥3 行 Snellen 视力表、3 名患者（14%）发生转移、1 名患者（5%）死亡。
疑似 CSCR 的患者，尤其是慢性患者，应通过散瞳眼底检查和多模态成像评估是否存在潜在的薄型脉络膜黑色素瘤。
