Ophthalmology in China ›› 2026, Vol. 35 ›› Issue (4): 285-289.doi: 10.13281/i.cnki.issn.1004-4469.2026.04.008

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Clinical and multimodal imaging characteristics of focal scleral nodules

Yan Yanni, Shi Xuehui, Wei Wenbin   

  1. Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Key Laboratory of Intelligent Diagnosis, Treatment and Prevention of Blinding Eye Diseases, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China

  • Received:2025-12-11 Online:2026-07-25 Published:2026-07-25
  • Contact: Wei Wenbin, Email: weiwenbintr@163.com
  • Supported by:
    National Natural Science Foundation of China (82220108017, 82141128); The Capital Health Research and Development of Special (2024-1-2052); Science & Technology Project of Beijing Municipal Science & Technology Commission (Z201100005520045); Sanming Project of Medicine in Shenzhen (SZSM 202311018)；R&D Program of Beijing Municipal Education Commission(SM202310025005)

Abstract: Objective To investigate the clinical features and multimodal fundus imaging characteristics of focal scleral nodules (FSN). Design Retrospective case series. Participants Six patients (6 eyes) diagnosed with FSN at Beijing Tongren Hospital between January 2023 and July 2025 were included. Methods All patients underwent comprehensive ophthalmic examinations, including best-corrected visual acuity, intraocular pressure, slit-lamp biomicroscopy, indirect ophthalmoscopy, color fundus photography, OCT, OCT angiography (OCTA), FFA, ICGA, and B-scan ultrasonography. Main Outcome Measures Fundus findings and imaging characteristics on OCT, OCTA, FFA, ICGA, and ultrasonography. Results Six patients (6 eyes) with FSN were included, all of whom were female. The best-corrected visual acuity in the affected eyes ranged from 0.8 to 1.0. All lesions presented as solitary, yellow-white, well-demarcated elevated nodules, 4-eye lesions located in the posterior pole. OCT demonstrated that all lesions were confined within the sclera, appearing as well-defined dome-shaped structures without definite choroidal involvement. The overlying choroid was progressively thinned due to upward compression by the scleral nodule, with the thinning most pronounced at the lesion margins. OCTA revealed choroidal flow voids within the lesion area. On FFA, the lesions showed hypo- or slight hyperfluorescence in the early phase with late staining, whereas ICGA demonstrated persistent hypofluorescence throughout all phases. Long-term follow-up was available in five cases. One lesion showed marked enlargement (from 3.29 mm×2.53 mm×0.88 mm to 7.83 mm×6.34 mm×2.07 mm) over 32 months and continued to progress despite photodynamic therapy, while the remaining lesions remained stable. Conclusions FSN is characterized by a solitary, well-defind yellow-white elevated subretinal nodule located posterior to the ocular equator. The characteristic OCT features of FSN consists of a roundish lesion localized within the sclera, accompanied by compressive thinning of the choroid and retina overlying the lesion. Most FSN lesions remain stable for a long time.


Key words:  , Focal scleral nodules；Optical coherence tomography；Multimodal imaging