OSLI Retina

September 2019

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586 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina ■ C A S E R E P O R T ■ Choroidal Nevus With Outer Retinal Atrophy Simulating Solar Retinopathy A. Kaan Gündüz, MD; Yağmur Seda Yeşiltaş, MD; Carol L. Shields, MD ABSTRACT: A 58-year-old man presented with visual distortion in the right eye for 2 years. His best-corrected visual acuity was 20/25 in each eye. Fundus examination revealed a macular pigmented lesion with central retinal pigment epithelial (RPE) atrophy and drusen in the right eye. Enhanced depth imaging optical coherence tomography (EDI- OCT) of the right eye showed a slightly elevated choroidal lesion with choroidal vascular compres- sion, optical shadowing, and trace cystoid macular edema. In addition, there was notable, prominent focal outer retinal atrophy simulating solar reti- nopathy, but the patient denied sun-gazing, laser pointer-gazing, and alkyl nitrate (popper) medica- tions. The final diagnosis was choroidal nevus with focal extensive outer retinal atrophy, giving a pseu- dosolar retinopathy appearance. Imaging with EDI- OCT provides indispensable information concern- ing retinal and RPE alterations overlying choroidal nevus and other choroidal lesions. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:586-588.] INTRODUCTION Choroidal nevus is a common benign intraocular tumor that occurs with a frequency of 5% to 6.5% of the adult white population. 1 Choroidal nevus can be associated with several retinal and retinal pigment epithelium (RPE) alterations including drusen, RPE hyperplasia, atrophy, detachment and fibrous metapla- sia, orange pigment, subretinal fluid (SRF), intraretinal edema, and choroidal neovascular membrane. 2 Over- lying RPE changes can be observed ophthalmoscopi- cally and are considered signs of chronicity, typically found over long-standing stable choroidal nevi. Optical coherence tomography (OCT) is a useful tool for visualization of potentially important overly- ing retinal and RPE changes associated with choroi- dal nevi. OCT findings such as SRF, RPE detachment, cystoid retinal edema, and RPE and photoreceptor loss can be predictive of visual loss over time. 3 Herein, we report a unique case of focal outer retinal damage over- lying choroidal nevus that initially simulated solar retinopathy. CASE REPORT A 58-year-old man presented with visual distortion of 2 years duration in the right eye. Past ocular and medical history was noncontributory. He denied sun- gazing, laser pointer-gazing, and alkyl nitrate (popper) medications. Ocular examination revealed best-cor- rected visual acuity of 20/25 in each eye. He was not myopic in either eye. Funduscopically, the right eye showed a brown macular hue, suggestive of choroidal nevus, measuring approximately 5.0 mm × 5.0 mm in basal diameter with oval central RPE atrophy and dru- sen (Figure 1a). There was no visible orange pigment or SRF. The left eye showed mild macular drusen con- sistent with early age-related macular degeneration. Imaging with enhanced depth imaging OCT (EDI- OCT) of the right eye revealed a slightly elevated solid choroidal lesion with gentle sloping anterior border, choroidal vascular compression, and deep shadowing, suggestive of choroidal nevus. Additional EDI-OCT demonstrated abrupt, focal outer retinal atrophy and trace cystoid retinal edema overlying the apex of the nevus (Figure 1b). Infrared autofluorescence (IRAF) revealed central hypoautofluorescence consistent with loss of RPE (Figure 1c). Fluorescein angiography (FA) showed a hypofluorescent lesion with a ring of central hyperfluorescence in early (Figure 1d) and late (Figure 1e) frames, compatible with window defect from RPE From the Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey (AKG, YSY); and Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia (CLS). Originally submitted September 22, 2018. Revision received February 19, 2019. Accepted for publication March 22, 2019. The authors report no relevant financial disclosures. Address correspondence to Kaan Gündüz, MD, Ankara University Faculty of Medicine, Department of Ophthalmology, Farilya Business Center 8/50, Ufuk Universitesi Cad, Çukurambar-Çankaya, Ankara, Turkey; email: drkaangunduz@gmail.com. doi: 10.3928/23258160-20190905-08

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