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PubMed1995

The atria of the fetal lateral ventricles: a sonographic study of normal atrial size and choroid plexus volume.

OBJECTIVE: Evaluation of the cerebral ventricular system is a routine part of all fetal sonographic examinations. Ventriculomegaly and decreased choroid volume are indicators of poor fetal outcome, so it is important to know the normal variation of these parameters. The present study describes the normal size of the fetal lateral ventricular atrium and the normal amount of choroid plexus within the atrium during the second and third trimesters. SUBJECTS AND METHODS: Six hundred eight consecutive, healthy, singleton fetuses from 13 to 42 weeks' menstrual age were examined prospectively. The atrium of the lateral ventricle was measured in the axial and coronal planes. For each axial measurement, the width of the choroid plexus was determined. RESULTS: An axial atrial measurement was obtained in 88% of the fetuses, and a coronal atrial measurement was obtained in 84%. The mean measurement and one standard deviation are 6.5 +/- 1.5 mm in the axial plane and 6.6 +/- 1.5 mm in the coronal plane. Ninety-eight percent of all measured atria were at least 60% filled by choroid plexus, and in all cases the atria were at least 50% filled. Complete filling by choroid plexus occurred in 58% of cases. CONCLUSION: This large prospective study confirms previous observations of mean atrial size. However, four standard deviations above the mean is 12 mm, suggesting currently used cutoffs for normal atrial size are too low. Other parameters, such as choroid plexus filling, may be helpful markers of normalcy in fetuses with atrial measurements between 8 and 12 mm.

Cerebral Ventricles↗
PubMed1993

Adrenergic innervation of the choroid and iris in diabetic rats.

We compared the distribution and density of ocular adrenergic nerves in rats after 3 to 13 months of streptozotocin diabetes and in age-matched control animals to learn whether diabetic sympathetic neuropathy is evident in the eye as it is in other organs. An aqueous aldehyde method for histochemical demonstration of catecholamines provided a clear and complete view of the adrenergic innervation in whole flat preparations of choroid and iris. In the choroid, a dense plexus of varicose nerve fibers invested all of the branching arterial blood vessels. A less dense network of nerves was present in the choroidal stroma between the arteries, but there was no obvious association of nerves with the venules draining choroidal capillaries. Using a stereological method to measure the density of the adrenergic plexus of choroidal arteries, we found the mean innervation density to be normal in diabetic animals sampled at 3, 9, and 13 months after onset of hyperglycemia. Microscopic examination also failed to reveal diabetes-associated changes in the diffuse stromal nerves of the choroid or in the rich adrenergic innervation of the iris. Diabetes of relatively long duration, therefore, does not obviously affect the density or distribution pattern of catecholamine-containing nerves supplying the rat eye.

Adrenergic Fibers↗
PubMed2002

Unusual case of extradural choroid plexus papilloma of the sacral canal. Case report.

An unusual case of a sacral, extradural choroid plexus papilloma involving the S1-3 level is described. This 50-year-old woman presented with a 4-month history of pain involving her right buttock, perineum, and leg. Contrast-enhanced magnetic resonance (MR) imaging of the spine revealed a well-defined, mildly enhancing sacral canal mass at the S1-3 level; its appearance was consistent with that of a benign tumor. Intraoperatively, the lesion was found to be extradural in location and was entwined among nerve roots in the sacral canal. Microscopic examination of the gross totally resected tumor revealed typical features of a choroid plexus papilloma. Despite performing a thorough neuroimaging workup (craniospinal contrast-enhanced MR imaging) for an intracranial or spinal primary mass, none was found. The choroid plexus appeared entirely normal; however, both a cavum septum pellucidum and a cavum vergae were noted. Extraneural choroid plexus papilloma, specifically intrasacral, extradural choroid plexus papilloma has not been previously reported. The present example is thought to have arisen either from ectopic choroid plexus tissue or perhaps by metaplasia from ependymal rests.

Choroid Plexus Neoplasms↗
PubMed1995

ICG-enhanced digital angiography and photocoagulation of choroidal neovascularization in age-related macular degeneration.

Choroidal neovascular membranes are often poorly defined on fluorescein angiography because of fluorescein leakage or blockage of hyperfluorescence by overlying hemorrhage, lipid, turbid fluid, or pigment. Indocyanine green (ICG) is a highly protein-bound dye in the near infrared portion of the spectrum. Therefore, ICG remained in and around the neovascular membrane and enhanced the visualization of certain membranes poorly defined with fluorescein. ICG penetrated through the overlying turbid tissue, and improved the visualization of the underlying choroidal neovascular membrane. Using an infrared angiography system, the authors obtained 21 ICG-angiograms with suspected choroidal neovascularization, and compared them to fluorescein angiograms. In 5 of the 21 eyes, occult choroidal neovascularization was well delineated on the ICG angiograms. In 2 eyes, we were able to detect a well-defined choroidal neovascular membrane underlying a subretinal hemorrhage. In 12 of the 21 eyes with choroidal neovascular membrane, we performed argon-green laser photocoagulation applying the overlay technique of the ICG angiogram to red-free photo or the early fluorescein angiogram, and evaluated the effect of full coverage laser treatment.

Choroid↗
PubMed1989

Histopathological and immunofluorescence study of the choroid plexus in hepatosplenic schistosomiasis mansoni.

A histopathological and immunofluorescence (IMF) study of the choroid plexus was performed in 8 cases of hepatosplenic schistosomiasis mansoni and in 20 cases which had resulted in death with no evidence of liver or brain involvement by schistosomiasis or other disease process, and in which renal disease and arterial hypertension were also excluded (control group). IgA, IgG, IgM, C3, and C1q were investigated. Positive IMF in the choroid plexus was found in 75% of the schistosomiasis group. IgA and IgG were the immunoglobulins (Ig) most frequently found. C3 was also commonplace. Histologic examination of the choroid plexus showed changes in 87.5% of the schistosomiasis group. The most frequently found change was characterized by focal, linear, occasionally nodular, subepithelial deposition of a homogeneous, acidophilic, and PAS positive substance, apparently in relation to the epithelial basement membrane, with thickening of this structure. In the control group, the IMF in the choroid plexus was negative in all cases, and only 2 cases (10%) presented histopathological changes of the choroid plexus with a pattern similar to that of the schistosomiasis group. The demonstration of the deposition of Ig and fractions of the complement system, and of histological changes in the choroid plexus in a liver disease which is known to exhibit circulating immune complexes and glomerulopathy with deposition of Ig and fractions of the complement system suggests an etiopathogenetic relationship between both findings.

Adolescent↗
PubMed1996

Isolated fetal choroid plexus cysts and karyotype analysis: is it necessary?

The purpose of this study was to evaluate the risk of fetal aneuploidy in the presence of isolated choroid plexus cysts and to evaluate the results obtained from our institution and those reported previously in the English literature. All patients with fetal choroid plexus cysts on prenatal ultrasonography were offered genetic counseling and amniocentesis for fetal karyotyping. Seven of 274 fetuses, 2.6% (95% confidence interval = 1.0 to 5.2%), with isolated choroid plexus cysts were aneuploid. Literature analysis located 23 other reports of 1537 fetuses with isolated choroid plexus cysts; 26 were karyotypically abnormal, 1.7% (95% confidence interval = 1.0 to 2.4%). When evaluating only those patients whose indication for amniocentesis was choroid plexus cysts (i.e., eliminating those patients with advanced maternal age or abnormal serum screening) the risk of having a fetus with trisomy 18 changed little, 1.9% (95% confidence interval = 0.4 to 5.5%). Our data, combined with those of the literature, suggest that the risk of finding an abnormal fetal karyotype in the presence of isolated choroid plexus cysts is at least 1% and may be as high as 2.4%. On the basis of these results, genetic counseling and prenatal diagnosis should be offered to these patients.

Aneuploidy↗
PubMed2006

Isolated choroid plexus separation on second-trimester sonography: natural history and postnatal importance.

OBJECTIVE: This study was undertaken to investigate the natural history and clinical importance of choroid plexus separation (a > or = 3 mm distance between the choroid plexus and medial wall of the lateral ventricle) as an isolated finding in the second trimester. METHODS: This was a 5-year retrospective review of an ultrasound database, looking for singleton fetuses with a menstrual age of 16 to 26 weeks and a finding of isolated choroid plexus separation. RESULTS: There were 78 cases available for study. The finding of choroid plexus separation was usually transient. Resolution was noted in 37% of the cases that were rescanned within 2 weeks and 71% of the cases that were rescanned more than 2 weeks after the initial diagnosis. Two abnormal karyotypes (trisomy 21 and 47,XXY) and 3 cases with abnormal development not associated with an abnormal karyotype were noted on neonatal follow-up. Cases with abnormal development were quite varied in their presentation. CONCLUSIONS: The finding of isolated choroid plexus separation is usually temporary, resolving in most cases within 4 weeks of the initial diagnosis. Most infants with this finding have no abnormalities. The clinical implication of the lone case of trisomy 21 was limited by a major preexisting risk in this patient. The 3 cases of abnormal development had varying presentations; the causal nature of this association is not yet clear. No trends were noted between the changing choroid plexus appearance with time and abnormal neonatal outcome, but the number of abnormal cases was quite limited.

Brain Diseases↗
PubMed1999

Demonstration of a coupled metabolism-efflux process at the choroid plexus as a mechanism of brain protection toward xenobiotics.

Brain homeostasis depends on the composition of both brain interstitial fluid and CSF. Whereas the former is largely controlled by the blood-brain barrier, the latter is regulated by a highly specialized blood-CSF interface, the choroid plexus epithelium, which acts either by controlling the influx of blood-borne compounds, or by clearing deleterious molecules and metabolites from CSF. To investigate mechanisms of brain protection at the choroid plexus, the blood-CSF barrier was reconstituted in vitro by culturing epithelial cells isolated from newborn rat choroid plexuses of either the fourth or the lateral ventricle. The cells grown in primary culture on semipermeable membranes established a pure polarized monolayer displaying structural and functional barrier features, (tight junctions, high electric resistance, low permeability to paracellular markers) and maintaining tissue-specific markers (transthyretin) and specific transporters for micronutriments (amino acids, nucleosides). In particular, the high enzymatic drug metabolism capacity of choroid plexus was preserved in the in vitro blood-CSF interface. Using this model, we demonstrated that choroid plexuses can act as an absolute blood-CSF barrier toward 1-naphthol, a cytotoxic, lipophilic model compound, by a coupled metabolism-efflux mechanism. This compound was metabolized in situ via uridine diphosphate glururonosyltransferase-catalyzed conjugation, and the cellular efflux of the glucurono-conjugate was mediated by a transporter predominantly located at the basolateral, i.e., blood-facing membrane. The transport process was temperature-dependent, probenecid-sensitive, and recognized other glucuronides. Efflux of 1-naphthol metabolite was inhibited by intracellular glutathione S-conjugates. This metabolism-polarized efflux process adds a new facet to the understanding of the protective functions of choroid plexuses.

Animals↗
PubMed1999

Differential expression of individual complement regulators in the brain and choroid plexus.

Membrane bound regulators of complement (C) control the system at key points during activation. To determine whether C regulators were expressed in the central nervous system, temporal cortex, and choroid plexus, tissues from eight adult humans were obtained at postmortem and surgery. Tissue was taken fresh for total RNA isolation, snap freezing, or processing in paraffin wax for immunocytochemistry and in situ hybridization. Immunocytochemistry of temporal cortex using anti-CD59 stained microglia intensely; astrocytes and neurons weakly. Microglia were unequivocally stained with anti-membrane cofactor protein (MCP) whereas staining on astrocytes and neurons was weak. Decay accelerating factor (DAF) was strongly expressed by microglia but weakly by astrocytes. Neurons expressed neither DAF nor complement receptor 1 (CR1). CR1 was also absent on astrocytes and microglia. The choroid plexus epithelium revealed intense apical staining with antibodies to CD59, less strongly with anti-MCP and weakly with anti-DAF. CR1 was detected only on phagocytic Kolmer cells in the choroid plexus. Reverse transcriptase-polymerase chain reaction revealed CD59, MCP, and to a lesser degree, DAF mRNA both in the choroid plexus and temporal cortex. CR1 mRNA was detected in choroid plexus samples only. Digoxigenin-UTP-labeled riboprobes to all four membrane regulators were used for in situ hybridization. DAF, MCP, and CD59 mRNA were expressed by epithelial cells of the choroid plexus and CR1 mRNA was found only in Kolmer cells. In the temporal cortex, MCP and CD59 mRNA were expressed by glia and at low level by neurons, but DAF was not detected. Previous studies have suggested that C produced in inflamed brains in conditions such as Alzheimer's and Huntington's diseases can be specifically toxic to neurons. The demonstration herein that neurons express only very low levels of CD59 and MCP and lack both CR1 and DAF might explain their susceptibility to C damage.

Adult↗
PubMed2000

Transscleral delivery of bioactive protein to the choroid and retina.

PURPOSE: To investigate the feasibility of transscleral drug delivery to the choroid and retina. METHODS: An osmotic pump was used to deliver IgG across the sclera of pigmented rabbits, and levels were measured in the choroid, retina, vitreous humor, aqueous humor, orbit, and plasma over 28 days. This method was then used to deliver an anti-intercellular adhesion molecule-1 (ICAM-1) monoclonal antibody (mAb), and its effect on inhibiting vascular endothelial growth factor (VEGF)-induced leukostasis in the choroid and retina was determined by measuring tissue myeloperoxidase (MPO) activity. RESULTS: Levels of retinal and choroidal IgG were significantly higher than baseline at all points up to 28 days (P < or = 0.01). IgG levels in the orbit, vitreous humor, aqueous humor, and plasma were negligible (P > 0.05). MPO activity in the choroid of eyes treated with anti-ICAM-1 mAb was 80% less (P = 0.01) than in eyes receiving an equal rate of delivery of an isotype control antibody. Inhibition of MPO activity in the retina was 70% (P = 0.01). The plasma concentration of anti-ICAM-1 mAb was 31,000-fold less than the concentration in the osmotic pump. CONCLUSIONS: Minimally invasive transscleral delivery can be used to deliver therapeutic levels of bioactive drugs to the choroid and retina with negligible systemic absorption. This method of ocular drug delivery may be used in the treatment of a variety of chorioretinal disorders.

Animals↗
PubMed2000

Choroidal neovascularization in the rat induced by adenovirus mediated expression of vascular endothelial growth factor.

PURPOSE: To determine the effects of an adenovirus vector encoding vascular endothelial growth factor(165) (Ad.VEGF) delivered to the subretinal space in the rat. METHODS: An E1-deleted adenoviral vector encoding VEGF was injected into the subretinal space of Long-Evans rats. Immunohistochemistry identified VEGF expression. Histopathologic changes in the retina were determined by light and electron microscopy, immunohistochemistry, fluorescein angiography, and examination of wholemounts of choroid and retina. RESULTS: Increased expression of VEGF only in the retinal pigment epithelium (RPE) was detected after Ad.VEGF injection. Histopathology of these eyes revealed minimal subretinal exudation at 1 week followed by the appearance of vascular structures in the subretinal space by week 2, which persisted up to 4 weeks. Shortening of photoreceptor outer segments and reduction of the outer nuclear layer were present overlying areas of neovascularization. Fluorescein angiography of animals injected with fluorescein-dextran revealed a deep complex of new vessels. Choroidal flatmounts showed new vessel formation, verified by detection of endothelial cells via immunohistochemistry, arising from the choroid with absence of change in the overlying retinal vasculature. Electron microscopy confirmed the presence of sub-RPE endothelial cells and pericytes and the loss of integrity of Bruch's membrane, and serial sectioning demonstrated choroidal vascular growth through Bruch's membrane. CONCLUSIONS: These results support the hypothesis that overexpression of VEGF from RPE cells is capable of inducing choroidal neovascularization in the rat and provide a framework for further examining angiogenic processes in the RPE-choroid complex.

Adenoviruses, Human↗
PubMed2000

Choroid plexus changes after temporal lobectomy.

BACKGROUND AND PURPOSE: Postoperative contrast-enhanced MR imaging of the brain is routinely used when evaluating for residual or recurrent brain tumor. It is imperative to be aware of morphologic changes and imaging features that typically occur in response to surgical manipulation at the postoperative site to avoid misinterpretation of imaging findings. Our purpose was to determine normal postoperative changes and alterations in the choroid plexus among patients who had undergone temporal lobectomy in order to distinguish this appearance from pathologic changes that may be seen in the presence of infection or recurrent tumors. METHODS: We reviewed 159 MR scans from 95 patients with hippocampal sclerosis or gliosis who underwent temporal lobectomy for treatment of intractable epilepsy. Choroid plexus location and size were assessed on contrast-enhanced T1-weighted images. RESULTS: After temporal lobectomy, the choroid plexus enlarged and sagged into the resection site. Increase in the size of the choroid plexus occurred in 58% of cases overall. The degree of enhancement also increased after surgery, sometimes resulting in a nodular pattern of enhancement. The changes were most marked during the 1st week after temporal lobectomy, and showed an enlarged, markedly enhancing choroid plexus on 86% of the scans. CONCLUSION: Postoperative changes of the choroid plexus after temporal lobectomy include sagging into the resection site, an increased size, and an increased degree of enhancement. Normal postoperative morphologic characteristics may mimic neoplastic enhancement pattern. Familiarity with this appearance is important to avoid a pitfall in diagnosis of recurrent postoperative temporal lobe neoplasms.

Adolescent↗
PubMed2000

[Choroidal folds in diabetic retinopathy].

PURPOSE: Choroidal folds are wrinkles of the inner part of the choroid, Bruch's membrane, retinal pigment epithelium and the outer retinal layers that produce alternate yellow and dark streaks. We have made a bibliographic checking of all of the causes and we have not found a clear relationship with diabetic retinopathy. Our purpose is to study a group of cases that we found with choroidal folds and diabetic retinopathy. METHODS: We have checked 1,019 angiographies of diabetic patients and we have found 16 cases with choroidal folds. Medical and ocular history have been analysed, as well as the state of the retinopathy and the morphology and pattern of the folds. RESULTS: All the cases had a similar pattern, bend shaped and horizontal, concentric, outside the macula and variable length. Changes of the appearance in the time have been demonstrated. 88% were women; 54% had a mild hyperopia (less than 2.5 diopters); 100% were diabetic type II and 85% insulin-dependent. The clinical appearance of the retinopathy was in 44% of moderate background, in 12% of severe background and in 44% of proliferative retinopathy. Arterial hypertension was the systemic disease more frequently associated (50%). CONCLUSIONS: We have found choroidal folds in patients with diabetic retinopathy of similar appearance. Changes observed in the time in angiographies reveal that, with high probability, they are acquired. The thick choroid that is developed in diabetics, together with the hypertensive retinopathy could be the cause of these folds.

Choroid↗
PubMed2001

Choroidal masses: a fourteen-year analysis.

BACKGROUND: Choroidal masses present much diversification in clinical features and incidence. The purpose of this study is to investigate the epidemiological and clinicopathological manifestations of different choroidal tumors in order to tabulate appropriate diagnostic approaches. METHODS: A retrospective analysis of patients with choroidal masses was conducted, the analysis being based upon the review of our medical records from January 1986 to December 1999 inclusively. A definite diagnosis of choroidal mass was confirmed by at least two experienced ophthalmologists. For patients who were enrolled in this study, an ophthalmic examination was conducted and medical history was recorded. Some ancillary tests, such as indirect ophthalmoscopy, ultrasonography, fluorescein angiography, computed tomography, and magnetic resonance imaging, were used to support the accuracy of our diagnoses. RESULTS: A total of 149 patients were enrolled in this study, of which 103 cases were excluded due to a loss of follow-up or incomplete medical records. Forty-six patients (51 eyes) included 12 cases (26%) of malignant metastases, 10 cases (22%) of hemangiomas, 2 cases (4%) of osteomas, 5 cases (11%) of melanocytomas, 8 cases (17%) of melanomas, and 9 cases (20%) of other melanocytic lesions. The male to female ratio was 21:25. The average length of follow-up was 20.5 months, and the average age of these patients was 42.8 years. Presenting with varied clinical incidence and pictures, each category of choroidal mass was investigated thoroughly. CONCLUSION: With more clinical experience and a better understanding of choroidal masses, we are able to propose an early differential diagnosis and therapeutic approach to the effective management of them in order to minimize ocular morbidity and improve patients' survival and quality of life.

Adult↗
PubMed2002

[Choroidal metastases in breast and lung cancer. Prevalence and clinical features. A prospective study].

PURPOSE: To analyze the prevalence of choroidal metastases in patients with breast and lung cancer and report their clinical, ophtalmological and angiographic features. MATERIAL AND METHOD: 88 patients who in 1997 had been diagnosed of breast cancer (60 cases) and lung cancer (28) by the oncology unit in the University Hospital of Elche, underwent a thorough ophtalmological examination in search for choroidal metastases. Eighty six patients were newly diagnosed of cancer; the remaining two patients, in a complete remission status, relapsed during this period. RESULTS: Total prevalence of choroidal metastases in the sample was 4.54% (4 cases). Prevalence in lung cancer was 7.14% (2 cases) compared to 3.33% (2 cases) in breast cancer. Choroidal involvement was found in the following stages: 2 out of 7 patients (28.5%) in stage IV with disseminated breast cancer and 2 out of 9 patients (22.22%) in stage IV with disseminated lung cancer. CONCLUSIONS: Approximately one fourth of the patients showing disseminated breast and lung cancer (stage IV) showed metastases in the choroid. It appears from this study, that younger patients suffering from lung cancer are at greater risk of choroidal involvement (Arch Soc Esp Oftalmol 2002; 77: 23-28).

Adult↗
PubMed1998

[The diagnostic value of high field MRI for choroidal melanoma].

OBJECTIVE: To clarify the characteristic magnetic resonance imaging (MRI) features of choroidal melanomas by the high field MRI to improve the accuracy of diagnosis and localization and to differentiate choroidal melanomas from other choroidal lesions. METHODS: 12 patients with choroidal melanomas were examined by GE 1.5T magnet and heat coil, fat suppression technique and GD-DPTA as contrast agent were also used. Ten patients underwent operations and the histopathologic diagnosis was confirmed. RESULTS: The melanomas of the 12 patients had relatively high signals on T(1) weighted image and relatively low signals on T(2) weighted image. This is because of the paramagnetic properties of melanin. The melanomas with melanin can produce stable free radicals, both T(1) and T(2) relaxation times are shortened, with this we can differentiate melanomas from other choroidal lesions. CONCLUSION: Sagittal, coronal, axial and oblique scanning with small feild of view for the orbit by MRI can be made to show the exact position of melanomas and differentiate them from other choroidal lesions.

Adult↗
PubMed2002

Expression of pigment epithelium-derived factor in normal adult rat eye and experimental choroidal neovascularization.

PURPOSE: Pigment epithelium-derived factor (PEDF) is a protein produced by the retinal pigment epithelial (RPE) cells. Recent studies have implicated PEDF in activities that are inhibitory to angiogenesis. In this study, the expression of PEDF was investigated in normal rat eyes and in eyes with experimentally induced choroidal neovascularization and compared with the expression of vascular endothelial growth factor (VEGF). METHODS: Choroidal neovascularization was induced by laser photocoagulation in rat eyes. At intervals of up to 2 weeks after photocoagulation, the eyes were removed and prepared for in situ hybridization and immunohistochemical study. In situ hybridization was performed with digoxigenin-labeled PEDF riboprobes. Protein expression of PEDF and VEGF was studied immunohistochemically. RESULTS: In normal adult rat eyes, PEDF mRNA was observed mainly in the corneal epithelial and endothelial cells, lens epithelial cells, ciliary epithelial cells, retinal ganglion cells, and the RPE cells. During the development of choroidal neovascularization, PEDF mRNA, PEDF protein, and VEGF protein were strongly detected in many cells within the laser lesions at 3 days after photocoagulation, after which levels gradually declined. However, PEDF was still expressed in the RPE cells that proliferated and covered the neovascular tissues at 2 weeks, whereas VEGF protein was weakly expressed in endothelial cells in choroidal neovascularization. CONCLUSIONS: PEDF is expressed in different cell types of normal rat eyes. The expression of PEDF was detected in the choroidal neovascular tissues induced by photocoagulation, and these findings suggest that PEDF may modulate the process of choroidal neovascularization.

Animals↗
PubMed2002

Diagnostic transvitreal fine-needle aspiration biopsy of small melanocytic choroidal tumors in nevus versus melanoma category.

PURPOSE: To report an experience with fine-needle aspiration biopsy of selected small melanocytic choroidal tumors during the interval from April 13, 1983, through January 19, 2001. METHODS: Retrospective descriptive case series report of 34 patients with a small melanocytic choroidal tumor (maximal diameter, < or = 10 mm; thickness, > or = 1.5 mm but < or = 3 mm) evaluated diagnostically by transvitreal fine-needle aspiration biopsy prior to treatment. None of the tumors had invasive features at the time of biopsy. RESULTS: Patients ranged in age from 26 to 73 years (mean, 50.9 years). The evaluated choroidal tumors had a mean maximal basal diameter of 8.0 mm and a mean maximal thickness of 2.4 mm. Eighteen of the 34 tumors (52.9%) had been documented to enlarge prior to biopsy. Biopsy was performed in all cases using a 25-gauge hollow lumen needle and a transvitreal approach via a pars plana puncture site. The biopsy yielded a sufficient aspirate for cytodiagnosis in 22 of 34 cases (64.7%). In these cases, the tumor was classified as malignant melanoma in 16 (47.1% of total), intermediate lesion in 4 (11.8%), and benign nevus in 2 (5.9%). The 12 tumors that yielded an insufficient aspirate and the four lesions that yielded intermediate cells continued to be classified as "nevus versus melanoma" and were monitored periodically for growth or other changes. Four of the 12 tumors that yielded an insufficient aspirate for cytodiagnosis and all four lesions that yielded intermediate cells were eventually reclassified as small choroidal melanomas and treated. The remaining eight tumors that yielded an insufficient aspirate and the two tumors that yielded benign nevus cells were classified as benign nevi at the most recent follow-up evaluation. CONCLUSIONS: Fine-needle aspiration biopsy showed that a substantial proportion of small melanocytic choroidal tumors likely to be classified clinically as small choroidal melanomas in many centers were in fact benign nevi or intermediate lesions.

Adult↗