Fundus autofluorescence of choroidal melanocytic lesions and the effect of treatment

Purpose: To correlate fundus autofluorescence (FAF) patterns in choroidal melanocytic lesions with changes present on the surface of such lesions, including lipofuscin, hyperpigmentation, drusen, and fibrous metaplasia, and to describe the effect of treatment on FAF. Methods: Retrospective chart review of 23 consecutive patients with choroidal nevi and melanoma who underwent FAF photography. The correlation between increased FAF patterns and foci of lipofuscin, hyperpigmentation, drusen, or fibrous metaplasia was defined as a complete correlation, partial correlation, or no correlation. The posttreatment FAF photographs of 6 patients with choroidal melanoma who were managed with plaque radiotherapy or plaque radiotherapy and transpupillary thermotherapy were also analyzed. Results: Lipofuscin was present in 13 tumors, hyperpigmentation in 9 tumors, drusen in 6 tumors, and fibrous metaplasia in 4 tumors. A complete correlation between increased FAF and lipofuscin was found in 8 tumors (61.5%), a partial correlation in 3 tumors (23.1%), and no correlation in 2 tumors (15.4%). A complete correlation between hyperpigmentation and increased FAF was found in 5 tumors (55.6%), a partial correlation in 3 tumors (33.3%), and no correlation in 1 tumor (11.1%). A partial correlation was found between drusen and increased FAF in all 4 tumors. A partial correlation was found between fibrous metaplasia and increased FAF in all 3 tumors. Following treatment, increased FAF was observed in 6 choroidal melanomas owing to an increase in lipofuscin and hyperpigmentation. Conclusions: Choroidal melanocytic lesions with overlying lipofuscin and hyperpigmentation are associated with increased FAF in about 90% of cases. Fundus autofluorescence photography may be helpful in evaluating small melanocytic tumors, since lipofuscin is a risk factor for growth. Following treatment, choroidal melanomas may show increased FAF.