Multimodal Imaging in Bilateral Isolated Choroidal Melanocytosis.

Abstract

Purpose: To report a rare case of bilateral isolated choroidal melanocytosis and highlight the need for thorough imaging evaluation.

Methods: Multimodal imaging, including ultra-widefield fundus photography, fundus autofluorescence, optical coherence tomography (OCT), and OCT angiography, was utilized to assess the findings.

Results: A 58-year-old hispanic female was referred for evaluation of unusual pigmentation in both eyes. She reported occasional floaters but had no other ocular symptoms. Dilated fundus examination and ultra-widefield color fundus imaging revealed extensive choroidal hyperpigmentation involving 360 degrees of the peripheral retina in both eyes. Fundus autofluorescence imaging demonstrated that the hyperpigmented regions were mildly hypofluorescent relative to the less pigmented central regions. Widefield OCT angiography demonstrated absence of any vascular abnormalities in the retina or inner choroid. Widefield structural OCT revealed normal retinal thickness and structure overlying the hyperpigmented areas. There was no choroidal elevation, but the choroidal stroma in the more peripheral regions of the fundus appeared more hyperreflective compared to the presumed normally pigmented central regions. While no choroidal elevation was noted, there was a mild increase in sub-foveal choroidal thickness. No evidence of scleral or periocular cutaneous pigmentation was observed. The overall findings, considering the patient's ethnicity and skin pigmentation, favored a diagnosis of bilateral idiopathic choroidal melanocytosis.

Conclusion: Bilateral isolated choroidal melanocytosis, can be diagnosed accurately through comprehensive imaging. Vigilant monitoring is essential due to the potential risk of malignant transformation.