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Dolz-Marco, Rosa MD, PhD*,†,‡; Sebrow, Dov B. MD*,†,§,¶; Freund, K. Bailey MD*,†,§,¶

Retinal Cases and Brief Reports: Fall 2019 - Volume 13 - Issue 4 - p 291–294
doi: 10.1097/ICB.0000000000000597
Case Report

Purpose: To report a case of “posterior scleral melanocytosis,” a pigmented lesion of the posterior sclera that clinically resembles a flat choroidal nevus.

Methods: Case report of a patient with posterior scleral melanocytosis. Multimodal imaging, including swept source optical coherence tomography, was used to demonstrate the scleral location of the pigmented lesion and to distinguish its features from a typical choroidal nevus present in the same eye.

Results: An 86-year-old woman was seen for regular follow-up for neovascular age-related macular degeneration in her right eye and 2 pigmented lesions in her left eye, both presumed to be choroidal nevi. Anterior segment examination showed no evidence of ocular or dermal melanocytosis. Optical coherence tomography of the pigmented lesion in the left eye showed two distinct patterns. One lesion showed hyperreflectivity within the choroidal tissue associated with posterior shadowing, whereas the second lesion showed normal choroidal reflectivity with hyperreflectivity confined to the inner sclera associated with marked posterior shadowing.

Conclusion: To the authors' knowledge, this is the first report of posterior scleral melanocytosis, a pigmented fundus lesion confined to the inner sclera. The need for high-penetrance optical coherence tomography to differentiate these lesions from a typical choroidal nevus may explain why this entity has not been previously described. The true nature of this entity will ultimately require histopathologic study.

The authors report the multimodal imaging findings of posterior scleral melanocytosis, a novel fundus finding localized by high-penetrance optical coherence tomography to the inner sclera, posterior to the choroidal–scleral junction.

*Vitreous Retina Macula Consultants of New York, New York, New York;

LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York;

Unit of Macula, Health Research Institute, University and Polytechnic Hospital La Fe, Valencia, Spain;

§Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, New York; and

Department of Ophthalmology, New York University School of Medicine, New York, New York.

Reprint requests: K. Bailey Freund, MD, Vitreous Retina Macula Consultants of New York, 460 Park Avenue, New York, NY 10022; e-mail:

Supported by The Macula Foundation Inc., New York, NY. R. Dolz-Marco: Research grants from Alcon, Allergan, Bayer, Heidelberg Engineering, Novartis, and Thea.

K. B. Freund: Consultant to Genentech, Optos, Optovue, Heidelberg Engineering, and Graybug Vision. Research support from Genentech. The remaining authors have no conflicting interests to disclose.

© 2019 by Ophthalmic Communications Society, Inc.