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Patient Presentation: A 23-year-old obese female was diagnosed with idiopathic intracranial hypertension (IIH) and referred to neurosurgery for ventriculoperitoneal shunt. A baseline ocular examination was performed prior to the procedure.
On examination, vision was 20/200 in the right eye, and 20/40 in the left eye. There was a right relative afferent pupillary defect. Slit lamp examination was normal.
A dilated fundus examination was performed demonstrating the following:
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Ocular Oncology
Case 4
Patient Presentation: A 64-year-old Caucasian female was referred to an ocular oncology clinic for a suspicious fundus lesion detected 3-weeks prior by an optometrist, as well as blurred vision OS. The patient’s past medical history included excision of a cervical pre-cancerous lesion.
Her best-corrected distance visual acuity was 20/20 OD and 20/30 OS with pressures within normal limits. Anterior segment and fundus examination was unremarkable, except for the amelanotic choroidal lesion demonstrated by the fundus photo, optos widefield and fundus autofluorescence images below:
Question: What tests are crucial in aiding in the diagnosis of this lesion?
A B-Scan ultrasound, with corresponding A-Scan, was completed and is shown below:
The B-Scan over the lesion demonstrates acoustic solidity, whereas the A-Scan notes medium -high reflectivity throughout the tumour thickness.
An OCT over the lesion was conducted and is shown below:
Question: What feature is NOT present in the OCT above?
Fluorescein angiography is shown of a lesion with the same diagnosis, which demonstrates progressive fluorescence and late homogenous staining below:
Question: Based on the above imaging, what is the most likely diagnosis?
Question: What is the treatment for choroidal hemangioma?
Learning Objectives:
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Describe the OCT and multimodal imaging features of choroidal hemangiomas.
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Differentiate choroidal hemangiomas from melanomas and lymphomas.
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