PURPOSE: To evaluate the long-term visual outcomes, recurrence, complication rate, and systemic associations of persistent placoid maculopathy (PPM). We also aimed to identify predictors of final visual acuity. METHODS:...PURPOSE: To evaluate the long-term visual outcomes, recurrence, complication rate, and systemic associations of persistent placoid maculopathy (PPM). We also aimed to identify predictors of final visual acuity. METHODS: This study combined a retrospective multicenter case series from three tertiary referral centers with a systematic review of the literature. Inclusion criteria were bilateral placoid macular lesions with characteristic multimodal imaging findings and a minimum follow-up of 23 months. Visual acuity, systemic associations, complications, recurrence, and treatments were assessed. RESULTS: Twenty-three patients (46 eyes) were included, 6 patients from our centers and 17 patients from the literature. The median follow-up was 3.75 years. Severe visual loss (< 20/100) at final follow-up was observed in one third of eyes. Choroidal neovascularization occurred in 65.2% of eyes and recurrence in 21.7%. Systemic cardiovascular comorbidities were common (87.5%) and two patients presented cerebral vasculitis. Systemic treatment was significantly associated with better final visual acuity (p = 0.014). CONCLUSION: PPM presents a high complication rate and poor visual prognosis. Systemic treatment was significantly associated with better final visual acuity in our study.
PURPOSE: To evaluate the anatomical and functional outcomes of a surgical approach combining amniotic membrane (AM) coverage with early vitrectomy under low perfusion pressure in patients with perforating globe injuries....PURPOSE: To evaluate the anatomical and functional outcomes of a surgical approach combining amniotic membrane (AM) coverage with early vitrectomy under low perfusion pressure in patients with perforating globe injuries. METHODS: The study involved nineteen patients who presented with zone 3 exit wounds of globe injuries. The surgical procedures included the administration of rt-PA for hemorrhage clearance, pars plana vitrectomy, internal limiting membrane peeling or retinectomy depending on the presence of PVR, application of AM over the exit wound, and intraocular tamponade injection. The postoperative follow-up period extended over six months. RESULTS: Anatomical success, defined as retinal reattachment, was achieved in 89.5% of cases, with a 100% rate of globe survival. The incidence of postoperative PVR was 10.5%. Best-corrected visual acuity improved in 89.47% of patients. CONCLUSION: The combination of AM coverage with early vitrectomy in the management of perforating globe injuries was associated with favorable anatomical outcomes, a low rate of postoperative PVR, and visual improvement in most patients. This approach represents a viable strategy for addressing the complex challenges in these severe ocular injuries.
Gregori G, Sahoo NK, Hasan N
… +7 more, Lupidi M, Saju S, Zhou A, Wykoff CC, Wu L, Chhablani J, Macula Society International CSCR Research Network (MICRoN)
PURPOSE: To investigate the association between mid-phase hyperfluorescent plaques (MPHP) with subretinal fluid (SRF) dynamics in central serous chorioretinopathy (CSCR) and to assess response across different therapeuti...PURPOSE: To investigate the association between mid-phase hyperfluorescent plaques (MPHP) with subretinal fluid (SRF) dynamics in central serous chorioretinopathy (CSCR) and to assess response across different therapeutic modalities using a validated quantitative approach. METHODS: This was a retrospective, multicenter study in patients with CSCR. All patients underwent baseline and follow-up indocyanine green angiography (ICG-A) and enhanced depth imaging optical coherence tomography (EDI-OCT). MPHP were measured on mid-phase ICG-A images, and changes in MPHP number and area were correlated with various imaging parameters. Response of MPHP to different treatment modalities were also evaluated. RESULTS: The study included 96 eyes of 60 patients, 50 males (83.33%) and 10 females (16.67%) with CSCR. Over a median follow-up of 31 months, significant reductions were observed in central macular thickness (p = 0.003), SRF height (p = 0.02), SFCT (p = 0.001), and MPHP area (p = 0.02), while MPHP number and BRVA remained stable. PDT and laser induced greater SRF reduction (-125.0 ± 143.2 µm and -123.8 ± 139.5 µm) and MPHP area decrease (-4.14 ± 6.13 mm2 and -1.75 ± 2.98 mm2, respectively) compared with eplerenone and observation (p < 0.01). Multivariable analysis confirmed PDT as the strongest independent predictor of MPHP area regression (p ≤ 0.001), while baseline SRF height and symptom duration predicted final SRF height (p ≤ 0.02). CONCLUSION: MPHP represent a frequent and dynamic angiographic feature in CSCR, closely associated with disease activity. PDT significantly reduced MPHP area and promoted SRF resolution, supporting its role as an effective treatment.
PURPOSE: To explore the relationship between the number of retinal lesions observed on ultra-wide field fundus photography (UWF-FP) and the non-perfusion index (NPI) quantified on UWF fluorescein angiography (UWF-FA) in...PURPOSE: To explore the relationship between the number of retinal lesions observed on ultra-wide field fundus photography (UWF-FP) and the non-perfusion index (NPI) quantified on UWF fluorescein angiography (UWF-FA) in patients with proliferative diabetic retinopathy (PDR). METHODS: The NPI was measured on early-phase UWF-FA in 100 eyes from 100 patients with PDR, including both type 1 and type 2 diabetes. Eyes were divided into quartiles based on NPI values. Red dots (microaneurysms, retinal hemorrhages, and intraretinal microvascular abnormalities), venous beading, cotton-wool spots (CWS), and white thread-like arterioles were counted on UWF-FP. RESULTS: Mean NPI values for quartiles 1 to 4 were 2.8 ± 1.1%, 8.5 ± 2.1%, 17.3 ± 4.5%, and 42.8 ± 12.2%, respectively. Eyes in the highest NPI quartile (quartile 4) had significantly fewer retinal lesions on UWF-FP (76.1 ± 50.6) and fewer CWS compared with those in the lowest NPI quartile, which showed 253.0 ± 165.5 retinal lesions (p < 0.001). White thread-like arterioles were present in 80.0% of eyes in quartile 4 and none in quartile 1. Patients in quartile 4 were predominantly type 2 diabetics with higher rates of end-stage kidney disease, peripheral neuropathy, lower-extremity peripheral artery disease, and prior limb amputation or revascularization. CONCLUSION: In patients with poorly controlled, long-standing type 2 diabetes complicated by renal failure, peripheral neuropathy, peripheral arterial disease, or lower-limb amputation, fluorescein angiography should be considered when highly ischemic PDR is suspected, particularly in the presence of white thread-like arterioles, as it may otherwise appear milder on color fundus photography.
PURPOSE: To report the clinical outcomes of a modified suture technique used for transscleral intraocular lens (IOL) fixation. METHODS: This study enrolled patients with aphakia, dislocated IOL, or crystalline lens luxat...PURPOSE: To report the clinical outcomes of a modified suture technique used for transscleral intraocular lens (IOL) fixation. METHODS: This study enrolled patients with aphakia, dislocated IOL, or crystalline lens luxation. All eyes underwent transscleral IOL fixation using the L-suture technique. The maximum tensile strength of the L-suture fixation was evaluated in vitro and compared to the Z-suture technique. Outcome measures included best-corrected visual acuity (BCVA), corneal endothelial cell density (ECD), IOL tilt, and postoperative complications. RESULTS: This case series included 35 eyes of 33 consecutive patients. The mean follow-up time was 21±7 months. The mean BCVA improved from 0.25±0.29 logMAR (Snellen 20/36) at baseline to 0.09±0.13 logMAR (Snellen 20/25) at the final follow-up (P=0.001). At the last visit, corneal endothelial cell count decreased by 7.2% (P<0.05), and the mean tilt angle of IOL was 2.91±2.21 degrees. Common intraoperative complications included subconjunctival hemorrhage occurred (5/35; 14.3%) and edematous conjunctiva (3/35; 8.6%). Postoperative complications included IOL iris capture (4/35; 11.4%) and transient ocular hypertension (4/35; 11.4%). In ex vivo testing, the maximum tensile strength of the L-suture fixation was higher than that of the Z-suture fixation (P<0.01). CONCLUSION: The L-suture technique provides a satisfying postoperative IOL position with robust fixation while minimizing invasiveness.
PURPOSE: Recent advances in inherited retinal disease (IRD) management, including genetic testing and emerging therapies, have increased complexity in clinical decision- making. This study examined IRD-related practice p...PURPOSE: Recent advances in inherited retinal disease (IRD) management, including genetic testing and emerging therapies, have increased complexity in clinical decision- making. This study examined IRD-related practice patterns among U.S. retina specialists. METHODS: An 18-item questionnaire developed by a combination of retina and IRD specialists (KCF, CCW, HK) was distributed electronically via email to retinal specialists at 35 non-university-based practices and 37 combined university-based/VA practices across the US. All retinal specialists at each institution were included and were assessed regarding their practice patterns for genetic testing, genetic counseling and education, referral to subspecialists or certified genetic counselors, and overall comfort level in assessing IRD patients. RESULTS: A total of 116 surveys were completed out of 481 distributed. 101 out of 116 (87.1%) indicated they actively manage IRD patients and were eligible to complete the survey in its entirety. Overall, most respondents were between the ages of 40-60 years old (58.6%). 54% were non-university employed, while 46% were university-employed. 60% reported comfort >3 (scale 1-5) in evaluating IRD patients. 92% of providers regularly send genetic tests, while 55% provide pretest counseling. Of the respondents, 92% performed post-test counseling. In-house genetic counselors were available to 40%. For post-test counseling, while almost all respondents actively see IRD patients, 51% stated they felt confident (>3, scale 1-5) interpreting genetic testing results. CONCLUSION: Over 90% of surveyed retinal specialists were involved in managing IRDs, but wide variation in practice and limited confidence highlight the need for clearer IRD care guidelines.
PURPOSE: The aim of this study was to evaluate the association between prostacyclin analog (PCA) therapy and the long-term incidence of diabetic retinopathy (DR) in patients with diabetes and pulmonary arterial hypertens...PURPOSE: The aim of this study was to evaluate the association between prostacyclin analog (PCA) therapy and the long-term incidence of diabetic retinopathy (DR) in patients with diabetes and pulmonary arterial hypertension. METHODS: In this retrospective, real-world cohort study, the authors used 1:1 propensity score matching within the TriNetX Global Collaborative Network to compare patients receiving dual therapy including PCAs versus matched controls treated with endothelin receptor antagonists, phosphodiesterase-5 inhibitors, or soluble guanylate cyclase stimulators without PCAs. Patients with a prior DR diagnosis were excluded. The incidence of nonproliferative DR, proliferative DR, and diabetes with ophthalmic complications was assessed over a 5-year period using Cox proportional hazards models and Kaplan-Meier survival analyses. RESULTS: Among 2,584 matched patients in both cohorts, PCA therapy was associated with a significantly lower incidence of nonproliferative DR (24 vs. 42 events; hazard ratio [HR] = 0.59; 95% confidence interval [CI], 0.35-0.97; P = 0.0345) and diabetes with ophthalmic complications (65 vs. 99 events; HR = 0.67; 95% CI, 0.49-0.91; P = 0.0105). No statistically significant difference was observed in proliferative DR incidence (10 vs. 15 events; HR = 0.63; 95% CI, 0.27-1.43; P = 0.2617). CONCLUSION: PCA therapy may be associated with a reduced risk of developing DR, suggesting potential systemic microvascular protective effects. Further prospective studies are warranted to explore the therapeutic role of PCAs in diabetes-related retinal disease.
PURPOSE: To better define the frequency and types of retinal pigment epithelial (RPE) tumors. METHODS: Retrospective review of all computer-coded RPE tumors over a five-decade period. RESULTS: Of 926 consecutive patients...PURPOSE: To better define the frequency and types of retinal pigment epithelial (RPE) tumors. METHODS: Retrospective review of all computer-coded RPE tumors over a five-decade period. RESULTS: Of 926 consecutive patients with RPE tumors, the specific diagnosis included solitary congenital hypertrophy of the retinal pigment epithelium (n = 727, 79%), multifocal congenital hypertrophy of the RPE (n = 42, 4%), torpedo maculopathy (n = 7, 1%), RPE hamartomas associated with familial adenomatous polyposis (n = 10, 1%), congenital simple hamartoma of the RPE (n = 5, 1%), combined hamartoma of the retina and RPE (n = 99, 11%), benign RPE adenoma (n = 34, 3%), and malignant RPE adenocarcinoma (n = 2, <1%). There were differences in RPE tumors regarding patient age (P < 0.01), race (P < 0.01), sex (P < 0.01), presenting visual acuity (P < 0.01), number of tumors (P < 0.01), tumor basal diameter (P < 0.01), tumor thickness (P < 0.01), and distance to the optic disc (P < 0.01) and foveola (P < 0.01). There were differences in RPE tumors regarding imaging with ultrasonography (P < 0.01), optical coherence tomography (P < 0.01), and prevalence of macular epiretinal membrane, cystoid macular, edema, and subretinal fluid on optical coherence tomography (P < 0.01). By autofluorescence and fluorescein angiography, nearly all lesions that were imaged were hypoautofluorescent/hypofluorescent except for combined hamartoma of the retina and RPE (P < 0.01). Outcomes revealed visual acuity loss ≥3 lines (≥15 letters) at 10 years more often in combined hamartoma of the retina and RPE (20%), adenoma (21%), and adenocarcinoma (100%) (P < 0.01) and 10-year nodular growth in congenital hypertrophy of the RPE (1%), adenoma (9%), and adenocarcinoma (100%) (P < 0.01). CONCLUSION: Retinal pigment epithelial tumors comprise a spectrum in demographics, clinical features, and outcomes. Most remain stable over time with little impact on visual acuity except for combined hamartoma of the retina and RPE, adenoma, and adenocarcinoma.
Bourdin A, Dureau S, Algret N
… +9 more, Malaise D, Lumbroso-Le Rouic L, Pierron G, Rais KA, Belkacem A, Piperno-Neumann S, Rodrigues M, Cassoux N, Matet A
PURPOSE: To report safety outcomes of transscleral fine-needle aspiration biopsy (FNAB) followed by irradiation for uveal melanoma (UM) in a tertiary ocular oncology center over 10 years, and assess whether FNAB modified...PURPOSE: To report safety outcomes of transscleral fine-needle aspiration biopsy (FNAB) followed by irradiation for uveal melanoma (UM) in a tertiary ocular oncology center over 10 years, and assess whether FNAB modified the overall prognosis of patients treated for primary UM. METHODS: Patients treated for UM between 2009 and 2020, eligible for conservative treatments by proton beam radiotherapy or Iodine-125 brachytherapy and to FNAB performed prior to UM treatment (tumor thickness 5-10 mm), were included retrospectively. Patients who underwent FNAB were compared to non-biopsied UM controls with similar characteristics, matched 1:1 using a propensity score. Complication rates, including local intraocular and extraocular relapse; metastases; and overall survival, were analyzed. RESULTS: Among 2,813 UM cases, 347 cases who underwent FNAB were matched to 347 controls. Median follow-up was 6.1 years (min=0.2-max=13.3). There was no difference in overall survival (OS) (p=0.25) and metastasis-free interval (MFI, p=0.68). Twenty-four cases (6.9%) and seventeen controls (4.9%) developed local intraocular recurrence (p=0.46). Extraocular relapses occurred in five cases (1.4%) and one control (0.3%), showing no statistical difference (p=0.12). Patients with monosomy 3 and chromosome 8 gain had significantly worse OS and MFI compared to those with normal 3 and 8 chromosomes, and to a lesser extent to those with either chromosomal alteration (p<0.0001). Those with monosomy 3 and chromosome 8 gain experienced more local recurrences (p=0.013). CONCLUSION: FNAB appears safe in terms of extraocular relapses, OS or MFI, but over the 2009-2020 period, accessing to primary UM somatic genetic features did not improve patient prognosis.
PURPOSE: To characterize vitreoretinal architecture in peripheral degenerative retinoschisis using high-resolution swept-source optical coherence tomography and to distinguish two morphologically and potentially mechanis...PURPOSE: To characterize vitreoretinal architecture in peripheral degenerative retinoschisis using high-resolution swept-source optical coherence tomography and to distinguish two morphologically and potentially mechanistically distinct forms of retinoschisis. METHODS: This retrospective imaging study evaluated eyes with peripheral degenerative retinoschisis using swept-source optical coherence tomography with extended dynamic-range processing and volume rendering. Retinoschisis was categorized as columnar retinoschisis, with residual intraretinal tissue columns, or bullous retinoschisis, with a large intraretinal cavity. Anatomical features were assessed descriptively and interpreted in the context of retinal physiology. RESULTS: Nineteen eyes of eleven patients were analyzed. All eyes demonstrated regions of columnar retinoschisis, and thirteen eyes also showed bullous retinoschisis. Vitreoschisis was identified only in eyes with bullous retinoschisis. Imaging commonly showed adherent cortical vitreous overlying schitic regions, with adjacent vitreous liquefaction, a configuration inconsistent with sustained traction as the sole explanation for the schisis cavity. Columnar retinoschisis was associated with limited separation between retinal layers and was typically contiguous with bullous schisis, which showed substantially greater intraretinal cavity height. CONCLUSIONS: These findings support the distinction between columnar and bullous retinoschisis as separate morphologic entities. While vitreous traction may contribute to initiation of retinoschisis, progression to bullous schisis may involve additional mechanisms. Loss of Müller cell columns may remove both a structural element that limits expansion of the schisis cavity and a pathway for intraretinal fluid regulation through the deep capillary plexus, allowing metabolic water production to contribute to cavity enlargement in the absence of sustained mechanical forces.
PURPOSE: To evaluate the safety and feasibility of a modified two-port, vitrectomy-free subretinal injection technique for gene therapy in patients with Bietti crystalline dystrophy. METHODS: Nineteen patients with Biett...PURPOSE: To evaluate the safety and feasibility of a modified two-port, vitrectomy-free subretinal injection technique for gene therapy in patients with Bietti crystalline dystrophy. METHODS: Nineteen patients with Bietti crystalline dystrophy underwent subretinal gene delivery using a two-port, vitrectomy-free surgical approach. Intraocular pressure was controlled via anterior chamber paracentesis. Patients were monitored for immune response, retinal integrity, cataract development, and visual changes during follow-up up to 2 years. RESULTS: The patients' ages ranged from 32 to 62 years (mean, 44±8 years, 10 males). All procedures were completed without intraoperative complications. The surgery time ranged from 9 to 14 minutes. Subretinal bleb resolved within 4 hours in 18 eyes and 72 hours in one eye, with delayed resolution after bed rest. No cataract formation was observed during follow-up. Visual acuity improved in 15 of 19 eyes (79%) at 6 months, 11 of 18 eyes (61%) at 1 year, and 5 of 10 eyes (50%) at 2 years. Three eyes (3/10, 30%) with visual decline at 2 years were not associated with cataract formation. CONCLUSIONS: This simplified, vitrectomy-free subretinal delivery technique appears feasible and safe. This approach may reduce early cataract risk; however, these observations remain preliminary and require confirmation in comparative studies with longer follow-up.
PURPOSE: To report the long-term outcomes of two-port non-vitrectomy endolaser therapy (TPNVE) in moderate-to-severe stage 3A Coats disease. METHODS: In this retrospective observational case series, patients with moderat...PURPOSE: To report the long-term outcomes of two-port non-vitrectomy endolaser therapy (TPNVE) in moderate-to-severe stage 3A Coats disease. METHODS: In this retrospective observational case series, patients with moderate-to-severe stage 3A Coats disease who were treated with TPNVE in a single tertiary referral vitreoretinal practice between March 2014 and May 2024 were included. The anatomic success rate, number of treatment sessions, and complications were analyzed. RESULTS: Of the 46 patients (47 eyes) included in the study, 33 (70.2%) eyes were stage 3A1, and the rest were stage 3A2. The mean (median, range) extent of ERD was 6.1 (5.0, 4.0-12.0) clock hours. The median (range) follow-up time was 67.7 (13.9-135.4) months. All 47 eyes achieved anatomic success with a median (range) treatment session of 2.0 (1-6) sessions. The median number of TPNVE treatments and conventional laser photocoagulation treatments was 1.2 (range, 1-2) and 0.0 (range, 0-4), respectively. Twenty (42.5%) eyes required only one session. There were 47 instances of recurrence in 27 eyes, of which over half (59.5%) took place in the first 6 months. Complications included cataracts in 11 (23.4%), vitreoretinal fibrosis in 11 (23.4%), subretinal fibrosis in 11 (23.4%), tractional retinal detachment in one (2.1%), and glaucoma in one (2.1%) of the eyes. CONCLUSIONS: TPNVE demonstrated efficacy in ablating abnormal vessels and reattaching the retina for moderate-to-severe stage 3A Coats disease. Approximately half of the eyes with an ERD extent of at least 4 clock hours achieved anatomical success after a single TPNVE surgery.
PURPOSE: To evaluate diabetic retinopathy (DR) severity, vision-threatening complications (VTCs), treatment patterns, and longitudinal outcomes among unhoused individuals with diabetes compared with stably housed control...PURPOSE: To evaluate diabetic retinopathy (DR) severity, vision-threatening complications (VTCs), treatment patterns, and longitudinal outcomes among unhoused individuals with diabetes compared with stably housed controls. METHODS: Using a large multicenter electronic health records network, patients with type 1 or type 2 diabetes were stratified by unhoused status via ICD-10 coding. Baseline DR severity, VTCs, and initial treatments were assessed across 9,643 unhoused and 1,180,509 housed patients. A secondary analysis requiring ≥6 months of ophthalmic follow-up yielded propensity score-matched cohorts of 2,911 patients each, with incident complications and treatments evaluated at one year. Multivariate Cox regression assessed the independent association between unhoused status and proliferative diabetic retinopathy (PDR) risk relative to other social determinants of health. RESULTS: At presentation, unhoused patients had significantly higher rates of PDR (5.24% vs 1.46%), vitreous hemorrhage (VH, 4.04% vs 1.03%), and tractional retinal detachment (TRD, 1.34% vs 0.24%) (all P<.01), and were less likely to achieve at least 6 months of follow-up (30.3% vs 55.2%; P<.01). In matched analysis, unhoused status increased 1-year risks of VH (hazard ratio [HR], 1.35; 95% confidence interval [CI], 1.08-1.69), diabetic macular edema (DME, HR, 1.28; 95% CI, 1.17-1.40), and PDR (HR, 1.25; 95% CI, 1.08-1.44). In multivariate analysis incorporating social determinants, unhoused status independently increased PDR risk (HR, 1.55; 95% CI, 1.41-1.71; P<.0001). CONCLUSIONS: Unhoused individuals present with more advanced DR, higher VTC rates, altered treatment patterns, and markedly reduced follow-up. These findings highlight unhoused status as a critical determinant of DR outcomes and underscore the need for targeted screening and socially informed ophthalmic care.
PURPOSE: To evaluate differences in the presentation patterns of Type 3 macular neovascularization (T3 MNV) secondary to age-related macular degeneration in Caucasian and Asian populations. METHODS: This retrospective, m...PURPOSE: To evaluate differences in the presentation patterns of Type 3 macular neovascularization (T3 MNV) secondary to age-related macular degeneration in Caucasian and Asian populations. METHODS: This retrospective, multicenter, comparative case series included treatment-naïve T3 MNV patients from Switzerland, Italy, and South Korea. All patients underwent comprehensive multimodal imaging. The topography of T3 MNV foci was mapped relative to the Early Treatment Diabetic Retinopathy Study(ETDRS) grid. Demographic and clinical variables were analyzed with respect to ethnicity, and discriminant score performance was assessed for differentiating Caucasian and Asian populations. RESULTS: A total of 301 eyes (181 European and 120 Korean) from 248 patients were included. Asian patients were significantly younger at presentation(76.1±6.9 vs. 81.1±6.1 years, p<0.001), with T3 MNV lesions located closer to the foveal center (mean distance: 810.7±329.0 vs. 1061.4±300.8 μm, p<0.001). Central ETDRS circle involvement was observed in Asians (17.5% vs 4.4%; p<0.001). Subfoveal choroidal thickness was similar between groups (154.1±72.1 vs. 153.3±71.0 μm, p=0.904). The prevalence of reticular pseudodrusen was higher in Caucasians than in Asians(89.0% vs. 74.2%; p=0.001). Multivariable analysis demonstrated that age(β=0.128, p<0.001), mean foveal distance (β=0.003, p<0.001) and RPD (β=1.150, p=0.003) had the strongest associations with ethnicity. In the discriminant model analysis, age and foveal distance emerged as significant discriminant features (Δ-C-index decreases=0.03 and 0.04, respectively). CONCLUSION: The presentation patterns of T3 MNV in the Caucasian and Asian populations demonstrated both shared and distinct characteristics. These findings suggest that while T3 MNV may involve common pathophysiological mechanisms across ethnicities, certain contributing factors may vary between populations.
PURPOSE: To characterize the clinical spectrum and age-distribution of pseudomelanomas in patients referred for suspected uveal melanoma at the largest ocular-oncology center in South Korea, where uveal melanoma incidenc...PURPOSE: To characterize the clinical spectrum and age-distribution of pseudomelanomas in patients referred for suspected uveal melanoma at the largest ocular-oncology center in South Korea, where uveal melanoma incidence is the lowest worldwide. METHODS: A retrospective review was conducted of consecutive patients referred for suspected uveal melanoma between January 2020 and August 2025. Diagnoses were confirmed using multimodal imaging. Patients were stratified into five groups (0-20, 21-40, 41-60, 61-80, and 81-100 years) to identify age-specific diagnostic patterns. RESULTS: Of 687 patients, 564 (82.1%) had pseudomelanomas and 123 (17.9%) had clinically confirmed melanoma, 81 of which had cytologic/pathologic confirmation. Common pseudomelanomas were choroidal nevus (N=120, 21.3%), congenital hypertrophy of the retinal pigment epithelium (CHRPE, N=70, 12.4%), choroidal hemangioma (N=53, 9.4%), choroidal metastasis (N=39, 6.9%), optic disc melanocytoma (N=35, 6.2%), and retinal capillary hemangioblastoma (N=32, 5.7%). Rare entities included vortex vein varix (N=7, 1.2%), posterior nodular scleritis (N=6, 1.1%), choroidal lymphoma (N=3, 0.5%), degenerative retinoschisis (N=2, 0.4%), RPE adenoma, uveal effusion, ciliary body schwannoma, ciliary body leiomyoma (N=1, 0.2%, respectively), etc. Uveal melanoma was absent in those aged 0-20 years and predominated in adults aged 41-80 years, along with nevus and metastasis, while CHRPE, retinal capillary hemangioblastoma, and choroidal osteoma were more common in ≤40 years. Peripheral exudative hemorrhagic chorioretinopathy was predominant in ≥81 years, while primary vitreoretinal lymphoma occurred in ≥61 years. CONCLUSIONS: Pseudomelanomas accounted for over 80% of suspected uveal melanoma cases in this Korean cohort, with age-specific distribution patterns. Recognizing pseudomelanomas features and these patterns may enhance diagnostic accuracy.