Swept-Source OCT Angiography Features of Melanotic Choroidal Tumors: An Analysis of 102 Consecutive Cases.

PURPOSE: To quantitatively analyze swept-source OCT angiography (SS-OCTA) features of choroidal melanoma and nevi, focusing on their distinguishing angiographic features.

DESIGN

Case-series study.

PARTICIPANTS

This retrospective study included 102 consecutive patients with choroidal melanoma or nevi who were referred to Beijing Tongren Hospital between July 2019 and June 2024.

MAIN OUTCOME MEASURES: The choriocapillaris and choroid slabs were en face reconstructed. A 5-grade system was developed based on the density and morphology of disorganized vasculature in the choroid slab. Choriocapillaris flow deficit (CCFD%) void was calculated within circular regions defined by the tumor's radius and diameter.

METHODS

This retrospective study included 102 consecutive patients with choroidal melanoma or nevi referred to Beijing Tongren Hospital between July 2019 and June 2024. The choriocapillaris and choroid slabs were en face reconstructed. A 5-grade system was developed based on the density and morphology of disorganized vasculature in the choroid slab. Choriocapillaris flow deficit (CCFD%) void was calculated within circular regions defined by the tumor's radius and diameter.

RESULTS

Of all the 102 patients, 87 (85%) patients with qualified SS-OCTA images, comprising 61 cases of choroidal melanoma and 26 cases of nevi. Sixty melanoma cases (98%) exhibited disorganized tumor vasculature forming twisted vessel loops and networks on the choroid slab (grade ≥2). Nevi showed 2 types of intrinsic tumor vasculature patterns in the choroidal slab: well-organized (grade 0 or 1) and melanoma-like disorganized networks (grade ≥2). Classified based on multimodal imaging risk score, nevi with a high risk for growth (≥2 risk factors) were more likely to exhibit melanoma-like disorganized networks tumor vasculature (82% vs. 27%, P = 0.015) than low-risk nevi. Analysis of the choriocapillaris slab revealed a higher prevalence of patchy avascular areas in melanomas compared to nevi. The CCFD% was significantly higher in choroidal melanomas than in nevi within circular regions defined by the tumor's radius (56.4% vs. 34.4%, P < 0.001) and diameter (44.9% vs. 23.4%, P < 0.001).

CONCLUSIONS

Swept-source OCT angiography enables detailed noninvasive assessment of intrinsic vasculature in melanotic choroidal tumors.

FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.