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César Adrián Gómez Valdivia
This 58YO Mexican female presented with 2 months of painless temporal visual field loss and photopsias in her left eye. Vision was 20/400.
Optos color RG imaging shows a large, elevated dome-shaped nasal choroidal mass with mottled pigmentation and overlying orange pigment. Orange material, likely lipofuscin, is noted along the nasal edge of the tumor, tracking along a major inferotemporal retinal arteriole. There was no exudative detachment. On fundus autofluorescence (FAF), the tumor is hypo-FAF. Variable granular hyper-FAF surrounds the mass and extends throughout the remainder of the fundus, sparing the superotemporal quadrant. B-scan ultrasonography shows a solid dome-shaped mass with homogeneous high internal reflectivity, measuring 7.04 mm in height and 13.36 mm in basal diameter. The tumor has intrinsic vascularity with late leakage.
Learning Points:
Exudative detachment is common in larger uveal malignant melanoma (MM). Our patient’s funduscopic inferior and macular pigmentary changes are a telltale finding indicating prior chronic subretinal fluid that spontaneously resolved. FAF is more sensitive than funduscopy at detecting outer retinal damage from chronic fluid, and our patient’s hyper-FAF represents unmasking from this outer retinal injury. Macular OCT (not shown) exhibited outer retinal band loss, which also suggested prior exudative detachment.
Uveal MM typically shows low-to-medium internal reflectivity on B-scan due to its comparatively homogeneous internal acoustic architecture (density of cellular interfaces, vascularity, necrosis, homogeneity). Hispanic and Mexican-Mestizo patients have tumors that are more heavily pigmented (Hudson et al., AJO 1994;118:57-62 and Delgado et al., Arch Soc Esp Oftalmol. 2018;93:15-22). However, a tumor’s pigmentation should not affect its reflectivity, and we don’t have a good explanation for our patient’s B-scan findings.
Our patient was referred to a tertiary care hospital for systemic evaluation, including a search for metastases and brain imaging. To our knowledge, she received stereotactic radiotherapy.
Retina. 2026 Oct 1;46(10):1644-1651. doi: 10.1097/IAE.0000000000004853.
Macular PVD commonly involves circumferential cortical tearing (rather than detachment) due to shallow angle of tractional forces. May contribute to subsequent ERM formation —Retrospective, volume-rendered SS-OCT, 53 eyes
Purpose: To characterize the structural features and mechanical failure patterns of macular posterior vitreous detachment using volume-rendered swept source optical coherence tomography and to analyze the forces governing cortical tearing versus vitreomacular separation.
Methods: In this retrospective study, eyes with developing or recent macular posterior vitreous detachment were imaged with swept source optical coherence tomography optimized for vitreous visualization by defocusing into the vitreous cavity. Volumetric data sets were processed and rendered three-dimensionally. Structural findings were analyzed descriptively and interpreted using vector-based mechanical modeling of cortical tensile forces and insertion geometry.
Results: Fifty-three eyes of 44 patients were imaged; 48 were evaluable. Circumferential tears of the posterior vitreous cortex were identified in 43 of 48 eyes (89.6%), including partial and complete tears. In a minority of eyes, detachment occurred without cortical rupture. The premacular bursa was preserved in partial tears and absent in complete tears. Measured insertion angles at the vitreomacular interface were shallow (<10°). Vector analysis demonstrated that at small insertion angles, the normal component of cortical tension is markedly attenuated (F⊥ = F sin θ), favoring cortical rupture at the insertion site over adhesive failure at the macula. Volume rendering demonstrated residual full-thickness cortical plaques adherent to the macular surface after tearing.
Conclusion: Volume-rendered swept source optical coherence tomography demonstrates that macular posterior vitreous detachment commonly involves circumferential cortical tearing. Mechanical analysis indicates that shallow insertion geometry favors cortical rupture as an initial failure mode, dissipating traction but leaving a residual cortical plaque that may contribute to subsequent epiretinal membrane formation.
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