Clinical Applications of Optical Coherence Tomography and Optical Coherence Tomography Angiography in Uveal Melanoma: A Narrative Review

Troisi M. Vitiello L. Lixi F. Timofte Zorila M.M. Abbinante G. Pellegrino A. Namazbayeva A. Adamo G.G. Coco G. Cuccu A. Giannaccare G.
October 2025 Multidisciplinary Digital Publishing Institute (MDPI)

Diagnostics
2025 #15 Issue 19

Uveal melanoma is the most common primary intraocular malignancy in adults, most frequently arising from the choroid, followed by the ciliary body and iris. Its diagnosis and management require precise characterization of tumor morphology, localization, and associated complications to optimize visual and systemic outcomes. Recent advances in optical coherence tomography (OCT), anterior segment OCT (AS-OCT), and OCT angiography (OCTA) have expanded the ophthalmologist’s ability to non-invasively visualize structural and vascular changes associated with this disease. In fact, enhanced depth imaging (EDI) and swept-source (SS) OCT can provide detailed views of deep ocular structures, enabling early detection of hallmark features such as subretinal fluid, retinal pigment epithelium disruption, and dome- or mushroom-shaped choroidal elevations; AS-OCT improves evaluation of lesions of the anterior segment, revealing iris architecture distortion and angle involvement; OCTA facilitates the visualization of abnormal tumor vasculature and detection of radiation-induced microvascular changes, including capillary dropout and foveal avascular zone enlargement. Moreover, these imaging modalities have demonstrated utility in differentiating uveal melanoma from pseudomelanomas, such as choroidal nevi, hemangiomas, and metastases. The present review aims at objectively assessing the use of OCT and OCTA in the diagnosis, treatment, and follow up of ocular melanoma, emphasizing their crucial role in identifying pathologic biomarkers of this potentially fatal ocular disease.

anterior segment imaging , artificial intelligence , choroidal imaging , choroidal melanoma , iris melanoma , multimodal imaging , ocular oncology , optical coherence tomography , optical coherence tomography angiography , uveal melanoma

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Eye Clinic, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, 80131, Italy
Ophthalmologic Unit, University Hospital of Salerno, Salerno, 84100, Italy
Eye Unit, Luigi Curto Hospital, Azienda Sanitaria Locale Salerno, Polla, 84035, Italy
Eye Clinic, Department of Surgical Sciences, University of Cagliari, Via Università 40, Cagliari, 09124, Italy
Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 16 Universitatii Street, Iasi, 700115, Romania
Department of Ophthalmology, Cai Ferate Clinical Hospital, 1 Garabet Ibraileanu Street, Iasi, 700506, Romania
Kazakh Eye Research Institute, Tole Bi Street 95a, Almaty, 050000, Kazakhstan
Department of Translational Medicine, University of Ferrara, Via Ludovico Ariosto 35, Ferarra, 44121, Italy
Sant’Anna University Hospital, Via Aldo Moro 8, Ferrara, 44124, Italy
Ophthalmology Unit, Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Via Montpellier 1, Rome, 00133, Italy

Eye Clinic
Ophthalmologic Unit
Eye Unit
Eye Clinic
Faculty of Medicine
Department of Ophthalmology
Kazakh Eye Research Institute
Department of Translational Medicine
Sant’Anna University Hospital
Ophthalmology Unit

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