Focal Scleral Nodule

Fung, Adrian T.; Waldstein, Sebastian M.; Gal-Or, Orly; Pellegrini, Marco; Preziosa, Chiara; Shields, Jerry A.; Welch, R Joel; Dolz-Marco, Rosa; Sarraf, David; Nagiel, Aaron; Lalane, Robert; Jung, Jesse J.; Ghazi, Nicola G.; Ramtohul, Prithvi; Arnold, Jennifer; Sakurada, Yoichi; Choudhry, Netan; Balaratnasingam, Chandrakumar; Freund, K. Bailey; Shields, Carol L.

doi:10.1016/j.ophtha.2020.04.018

Cited by 21 publications

(23 citation statements)

References 25 publications

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“…Focal scleral nodule (FSN), renamed by Fung et al in 2020 [1], is characterized by the partial elevation of the sclera and a solitary yellowish-white spot with clear boundaries. In the FSN lesion, the choroidal circulation may be locally impaired given previously reported hypofluorescence on indocyanine green angiography (ICGA) and nonperfusion of choriocapillaris on optical coherence tomography angiography [1]. To date, surveying macular choroidal blood flow using laser speckle flowgraphy (LSFG) has played an important role in elucidating the pathophysiology of various fundus diseases [2][3][4][5][6][7][8]; however, the LSFG findings of FSN has not been reported so far.…”

Section: Dear Editormentioning

confidence: 99%

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confidence: 99%

“…Since the yellowish-white lesion in this disease was once considered an inflammatory disease of the choroid, Hong et al named it unifocal helicoid choroiditis in 1997 [ 9 ], and Shields et al solitary idiopathic choroiditis in 2002 [ 10 ]. However, recent EDI-OCT findings prompted Fung et al to rename these lesions to FSN, reporting that these lesions originate from the sclera and not the choroid [ 1 ]. In both cases of this report, the cooler LSFG color showed a focal reduction in blood flow.…”

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confidence: 99%

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Laser speckle flowgraphy findings in focal scleral nodule

Yamashita

Saito

Hirooka

et al. 2021

Graefes Arch Clin Exp Ophthalmol

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Section: Dear Editormentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Laser speckle flowgraphy findings in focal scleral nodule

Yamashita

Saito

Hirooka

et al. 2021

Graefes Arch Clin Exp Ophthalmol

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“…Because of its scleral location and the absence of any signs of inflammation, we propose the term “idiopathic scleroma” for this lesion. Such nomenclature should discourage unnecessary systemic investigations for inflammatory disease and perhaps immunosuppressive therapy, which some might administer because of the term “solitary idiopathic choroiditis.” Others have recently reported similar findings in a series of 63 patients with unilateral findings and proposed the term “focal scleral nodule” for this lesion [10].…”

Section: Discussionmentioning

confidence: 60%

A Case Series of “Solitary Idiopathic Choroiditis” and Proposal of a Nomenclature Change to “Idiopathic Scleroma”

et al. 2020

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Objective: To define the characteristics of solitary idiopathic choroiditis (SIC) in a consecutive series of patients and propose a nomenclature change to idiopathic scleroma. Materials and Methods: Electronic patient records were retrospectively interrogated to identify all patients diagnosed with SIC between 2002 and 2019 in a tertiary referral ophthalmic hospital in the United Kingdom. Results: Thirty-four eyes of 34 patients were found to have SIC. The mean age at diagnosis was 48 years (range 24–78) and 23 patients (68%) were female. All lesions were located posterior to the equator, most frequently in the inferotemporal quadrant (13 eyes, 38%). The lesions had a mean largest basal diameter of 1.2 ± 0.4 disc diameters (range 0.5–2) and their distance to the optic disc had a mean of 1.2 ± 0.9 disc diameters (range 0–3.3). All lesions were intrascleral on enhanced depth imaging optical coherence tomography, demonstrating a hypo-reflective zone within the sclera, with an underlying hyper-reflective zone in some cases. No lesion enlarged or developed features consistent with active inflammation after a median follow-up time of 0.9 years (range 0–16.8). Discussion/Conclusion: Optical coherence tomography shows SIC to be an intrascleral lesion. Furthermore, we found no evidence of any inflammatory component. A nomenclature change to idiopathic scleroma is appropriate to prevent unnecessary investigation.

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“…Focal scleral nodule (FSN) is a rare condition characterized by an elevated, solitary, yellow–white lesion typically 1 disk area, located in the postequatorial region. 1 It was previously termed as unifocal helioid choroiditis by Hong et al 2 and also as solitary idiopathic choroiditis by Shields et al, 3 who both proposed that the lesion originated from choroidal granulomatous inflammation. In 2020, Fung et al 1 renamed the lesion as FSN, given that multimodal imaging including enhanced-depth optical coherence tomography (OCT) and swept-source OCT revealed the pathologic conditions to be intrascleral, not choroidal.…”

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confidence: 99%

Pigmentation in Focal Scleral Nodule

Mok

Fung

2023

RETINAL Cases &Amp; Brief Reports

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Purpose: To report a case of pigmentation in focal scleral nodule (FSN). Methods: This is a single case report.Result: An asymptomatic 61-year-old woman was referred with small, partially pigmented raised lesion located at the superior margin of the optic nerve head. The lesion's clinical and multimodal imaging features were consistent for FSN including a dome-shaped elevation confined to the sclera with overlying choroidal thinning. However, the pigmentation within our lesion is a novel finding in FSN that has not been described before.Conclusion: To our knowledge, we report the first case of pigmentation in FSN. It is likely that our case was a typical FSN that then became pigmented, with melanosomes involving the flanges of the lesion where thin choroid remains. The understanding that FSN can be partially pigmented may eventually help unravel the origins of this poorly understood lesion.

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Focal Scleral Nodule

Cited by 21 publications

References 25 publications

Laser speckle flowgraphy findings in focal scleral nodule

Laser speckle flowgraphy findings in focal scleral nodule

A Case Series of “Solitary Idiopathic Choroiditis” and Proposal of a Nomenclature Change to “Idiopathic Scleroma”

Pigmentation in Focal Scleral Nodule

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