NOVEL MULTIMODAL IMAGING IN BILATERAL DIFFUSE UVEAL MELANOCYTIC PROLIFERATION AND CHANGE IN THE FINDINGS DURING FOLLOW-UP AND TREATMENT.

Abstract

To describe the advanced multimodal imaging findings of patients with bilateral diffuse uveal melanocytic proliferation and the changes in these findings over time. Fundus photography, fundus autofluorescence, fundus fluorescein angiography, spectral domain optical coherence tomography, B-scan ultrasonography, and ultrasound biomicroscopy images of the patients diagnosed with bilateral diffuse uveal melanocytic proliferation at a single institution between years 2006 and 2023 were evaluated. Sixteen eyes of eight patients with bilateral diffuse uveal melanocytic proliferation were included. The median age was 68 years (range: 49-77 years), and the median follow-up time was 11 months (range: 1-79 months). The most common fundus photography findings were pigmentary changes and diffuse orange pigment patches in the posterior pole. The giraffe/leopard pattern of hyperfluorescence on the posterior pole was the most prominent finding in fundus autofluorescence and fluorescein angiography. Different from previous reports, intraretinal hyperreflective foci, outer retinal tubulations, subretinal fibrosis, and bacillary layer detachment in optical coherence tomography; optic disc hyperfluorescence and peripheral vascular leakage in fluorescein angiography; 360° ciliary body thickening; and anterior rotation of the ciliary body in ultrasound biomicroscopy were detected. We presented various novel multimodal imaging features of bilateral diffuse uveal melanocytic proliferation that may warrant updating current diagnostic criteria and their changes over time. Our newly defined findings also suggest a possible inflammatory component to bilateral diffuse uveal melanocytic proliferation pathogenesis, which may have implications for treatment.