Near-infrared transillumination photography to detect anterior uveal melanomas through black IOLs

Krohn et al describe a novel photographic technique using near-infrared (NIR) transillumination to detect peripheral anterior choroidal and ciliary body melanomas not visible on slit lamp examination. The described imaging technique uses a broad spectrum background light source to illuminate the fundus and external photography with a 720–1100 nm NIR filter to evaluate anterior uveal masses, permitting topographical description of tumour location in relation to the ciliary body and ora serrata. 2 NIR transillumination photography may serve another essential clinical application as the first diagnostic technique described capable of detecting anterior uveal melanomas in patients implanted with black intraocular lenses (IOLs) who cannot undergo slit lamp examination. Black IOLs are indicated in patients with intractable diplopia, visual confusion, unsightly leucocoria and a range of neuro-ophthalmic disorders. Despite high rates of postoperative satisfaction in patients, their use has been restricted by concerns from ophthalmologists that an inability to visualise the retina may prevent the identification of life-threatening pathology—principally uveal melanoma— behind the occlusive IOL. Morcher black IOLs have been demonstrated to transmit high levels of NIR light. This property permits high quality imaging of the macula and optic nerve using scanning laser ophthalmoscopy and optical coherence tomography with any imaging system in clinical use. However, conventional non-contact scanning laser ophthalmoscopy (SLO)/optical coherence tomography (OCT) imaging is restricted to a field 30° around the foveal centre and cannot detect melanomas located anteriorly in the uveal tract. Transmission spectra of Morcher black IOLs have demonstrated exponential light transmission from 750 nm, transmitting 99%–100% of SLO/OCT scanning wavelength light (820–870 nm) (figure 1).