Optical coherence tomography for the differential diagnosis of age-related macular degeneration and choroidal neoplasms

The exudative form of age-related macular degeneration (AMD) requires differential diagnosis from centrally localized choroidal neoplasms, particularly choroidal melanoma. It is important to consider that these conditions can often coexist, complicating the diagnostic process. Studies dedicated to the use of optical coherence tomography (OCT) for differentiating AMD and choroidal tumors are scarce. Objective: to determine the structural OCT differences between exudative AMD, choroidal melanoma (CM), and choroidal hemangioma (CH) localized in the central fundus area. Materials and methods. The study included 60 patients referred for consultation with suspected centrally localized choroidal neoplasms. The average age at the time of examination was 60.75 ± 15.36 years; the mean prominence of the lesion according to ultrasound (US) was 1.81 ± 1.44 mm, and the average diameter was 8.31 ± 1.44 mm. All patients underwent OCT in standard and Enhanced Depth Imaging (EDI) modes using the OCT Spectralis (Heidelberg Engineering, Germany). OCT scans were analyzed for the condition of the “choroidal complex”, the choroid in the area adjacent to the lesion, the integrity of Bruch’s membrane, the state of the retinal pigment epithelium (RPE), the presence or absence of neuroepithelial detachment (NED) and cystic changes, as well as the ability to differentiate retinal layers. Results. For AMD, the key differential diagnostic OCT criterion is the absence of choroidal elevation, with significant retinal changes at the surface level. These changes are characterized by RPE detachment, extensive hyperreflective foci (ophthalmoscopically corresponding to scarring), and destructive changes in the overlying retinal layers. OCT features of choroidal tumors include elevation of the “choroidal complex” with less pronounced changes in the overlying retina. The structure of the “choroidal complex” varies depending on the nature of the pathological process. In CM and CH, changes in the RPE and the adjacent retina are less pronounced and occur secondarily due to choroidal vessel compression by the growing tumor and their obliteration in CM or pathological changes in the intrinsic choroidal vessels in CH. Conclusion. In the differential diagnosis of AMD and centrally localized choroidal neoplasms, attention should be paid to the condition of the “choroidal complex” and Bruch’s membrane in the area of interest when analyzing OCT findings.

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