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This 49YO female complained of 2 months of distorted and blurred vision in her right eye and was referred for a possible uveal malignant melanoma (MM). Vision was 20/200 OD and 20/40 in her normal OS.
Optos color RG imaging shows a hyperpigmented subretinal lesion measuring 10.8×8.6 mm centered beneath the superotemporal arcade. However, both RGB imaging and Triton color photography reveal that this lesion is orange. A hyporeflective 1.4mm thickened choroidal lesion is noted on OCT scanning with mild subfoveal fluid. Fundus autofluorescence (FAF) shows the lesion to have a central mottled hyper- and hypo-FAF appearance, with surrounding hyper-FAF extending inferiorly.
Learning Points:
Isolated choroidal hemangiomas are benign vascular lesions. Although they have no malignant potential, they can cause vision loss from exudation leading to subretinal and intraretinal fluid, which can be treated with photodynamic therapy (see Tsipursky et al., Surv Ophthalmology 2011;56:68-85).
This lesion was initially misdiagnosed as a uveal malignant melanoma based on the hyperpigmented appearance on Optos RG imaging. This has also been reported in the literature (Becker et al, OSLIR 2023;54:292-296). These images are generated from a red (635nm) and green (532nm) laser. This creates a greenish tint, which distorts the true fundus color. In our patient, this was quite dramatic, with the true orange color of the hemangioma only evident in the Triton image. A newer Optos true color RGB unit has recently been introduced, which maintains the ability to view the separate RG channels but also generates a true-to-life color image.
Photodynamic therapy was performed for the foveal fluid. Six weeks later, the fluid completely resolved and vision remained stable at 20/100. We will continue to follow her closely.
Can J Ophthalmol. 2026 Aug;61(4):978-981. doi: 10.1016/j.jcjo.2026.02.008.
Eyes with nasal ROP (vs temporal-only disease) at initial presentation are more likely to require treatment — Retrospective, 542 eyes.
Objective: Recognition of factors associated with a greater need for treatment may be useful in managing retinopathy of prematurity (ROP). We aim to assess the relationship between nasal and temporal ROP on initial presentation and an infant’s eventual need for treatment.
Methods: All patients screened for ROP between January 2018 and December 2020 were retrospectively reviewed. Data were collected on all patients (n = 286) with stage 1 or higher ROP. Eyes were classified as either nasal ROP or temporal-only ROP at initial presentation of ROP. Data from all ROP screening exams until treatment or completion of screening were reviewed. The primary outcome was treatment-required ROP. Additional data collected included birth weight, patient age, and laterality. Outcomes were compared using univariable and multivariable logistic regression analyses.
Results: Five hundred forty-two eyes were included for analysis. Eyes with nasal ROP on initial presentation were more likely to ultimately require treatment (63/197 [32%]) than eyes with temporal-only ROP on initial presentation (13/345 [4%]; odds ratio [OR]: 12.0, 95% CI: 6.40-22.54) using a univariable logistic regression analysis. A separate multivariable regression analysis demonstrated that eyes with nasal ROP remain more likely to require treatment (OR: 3.28, 95% CI: 1.54-6.99), even when also accounting for birth weight (OR: 0.40/100 g, 95% CI: 0.32-0.51), patient sex, and laterality.
Conclusions: Eyes with nasal ROP at initial presentation are more likely to eventually require treatment than those with temporal-only ROP at initial presentation, even when accounting for other risk factors. Nasal ROP at initial presentation should prompt particular attention when monitoring for progression of ROP.
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