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Evolving imaging technologies enhance evaluation, management of intraocular malignancies
CHICAGO — Novel and advanced technologies are critical for the evaluation and management of patients with ocular malignancies, a speaker said here.
“[Spectral-domain optical coherence tomography] has become critical in detecting and targeting anti-VEGF therapy in patients with radiation-associated complications, including radiation maculopathy,” Timothy G. Murray, MD, told colleagues at Retina Subspecialty Day preceding the joint meeting of the American Academy of Ophthalmology and Asia-Pacific Academy of Ophthalmology.
Because of improvements in both axial and lateral resolution, digital B-scan echography has become a mainstay in management of patients with intraocular malignancy, both in their evaluation and diagnostic follow-up, Murray said.
“Novel technologies have included intraoperative imaging, particularly in our pediatric patients,” he said. “Enhanced depth imaging may uniquely delineate tumor thickness for small tumors but is inherently limited based on the pigmentation of the tumor and its associated thickness.”
Enhanced depth imaging, however, may allow for stratification of risk for movement from a nevus to an atypical nevus to a small malignant melanoma, he said.
Imaging characteristics that appear most important are photoreceptor degeneration, retinal pigment epithelium drusenoid changes, intraretinal cystic edema and subretinal fluid.
“Intraoperative pediatric imaging is now a mainstay in most pediatric oncology services,” Murray said.
Constraints include the need for evaluation during general anesthesia, supine positioning, and new recognition of the importance of registration, reproducibility and image quality, he noted.
Noncontact widefield fluorescein indocyanine green angiography has a 150° field of view and is useful for both evaluation of tumor vasculature and surrounding retinal choroidal vasculature, he said.
“These imaging technologies have enabled amazing improvements in accuracy, follow-up, targeted delivery of pharmacotherapy, and particularly an enhanced understanding of pediatric retinal and ocular pathology,” Murray said.
Disclosure: Murray has no relevant financial disclosures.