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Imaging the Microvasculature of Choroidal Melanomas With Confocal Indocyanine Green Scanning Laser Ophthalmoscopy
Arthur J. Mueller, MD, PhD;
Dirk-Uwe Bartsch, PhD;
Robert Folberg, MD;
Mary G. Mehaffey, MD;
H. Culver Boldt, MD;
Margaret Meyer;
Lynn M. Gardner;
Michael H. Goldbaum, MD;
Jacob Pe'er, MD;
William R. Freeman, MD
Arch Ophthalmol. 1998;116:31-39.
Objective To image the microvasculature of choroidal melanoma with a new confocal scanning laser ophthalmoscope.
Methods Eighteen consecutive patients, each with a unilateral choroidal melanoma, were examined prospectively. Indocyanine green angiography was performed with a new confocal scanning laser ophthalmoscope that enabled serial optical sectioning through the tumor. Two additional patients were studied with indocyanine green angiography and confocal scanning laser ophthalmoscopy just before enucleation for posterior choroidal melanomas. The histologic identification of microvasculature patterns was compared with the angiograms for these patients.
Results In the series of 18 patients, 16 (89%) indocyanine green angiograms with optical sectioning revealed tubular structures within the melanoma that were identified as tumor vessels based on their angiographic appearance. The microvasculature patterns identified by indocyanine green angiography correlated well with the histologic appearance of these microvasculature patterns in both patients for whom histologic verification was available.
Conclusions This preliminary study suggests that indocyanine green angiography with confocal scanning laser ophthalmoscopy images the microvasculature of choroidal melanomas and may be capable of detecting microvasculature patterns that have been shown to be prognostically significant from histopathological studies.
From the Department of Ophthalmology, Shiley Eye Center, University of California, San Diego, La Jolla (Drs Mueller, Bartsch, Goldbaum, and Freeman); Departments of Ophthalmology and Pathology, University of Iowa, Iowa City (Drs Folberg, Mehaffey, and Boldt and Mss Meyer and Gardner); and Department of Ophthalmology, Hadassah University Hospital, Jerusalem, Israel (Dr Pe'er).
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