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Balasubramaniam SC, Dalvin LA, Bakri SJ. Prevalence of intraocular tumours detected by ultrasonography in eyes with opaque media. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:46-49. [PMID: 36244400 DOI: 10.1016/j.jcjo.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 09/10/2022] [Accepted: 09/15/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To study the prevalence of intraocular tumours detected by screening ultrasonography in eyes with opaque media. METHODS Retrospective review of B-scan ultrasonography in eyes with opaque media and diagnosis of blindness or phthisis between January 1, 1994, and December 31, 2013. Ultrasounds for diagnostic purposes in acute endophthalmitis, retinal detachment, or vitreous hemorrhage were excluded. RESULTS There were 119 blind eyes with opaque media examined with B-scan ultrasonography. Mean patient age was 59 years, with visual acuity of hand motions or worse in 89 eyes (74.8%), elevated intraocular pressure in 23 eyes (19.3%), and pain in 30 eyes (25.4%). Follow-up was ≥1 year in 69 eyes (58%) with a mean 64 months (median, 56 months; range, 12-129 months). Of these 69 eyes, ultrasound frequency was more often than annual in 2 eyes (2.9%), annual in 2 eyes (2.9%), every 13-60 months in 43 eyes (62%), every 61-120 months in 19 eyes (27.5%), and less often than every 120 months in 3 eyes (4.3%). Sixteen eyes with opaque media only received ultrasound at presentation, and 6 eyes had screening ultrasonography only prior to evisceration or enucleation. No intraocular tumours were detected in any eye during the study period. CONCLUSIONS In this series, no intraocular tumours were detected by screening ultrasonography in eyes with opaque media. Larger studies with long-term follow-up are required to determine the utility and cost-effectiveness of serial ultrasonography monitoring. Ultrasound may have its highest utility in the setting of initial evaluation, clinical change, and preoperative work-up to avoid evisceration in the setting of occult malignancy.
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Affiliation(s)
| | | | - Sophie J Bakri
- Department of Ophthalmology, Mayo Clinic, Rochester, MN.
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Berger T, Flockerzi F, Löw U, Flockerzi E, Aljundi W, Abdin A, Daas L, Seitz B. Corneal Perforation as a Rare and Late Manifestation of Choroidal Melanoma. Klin Monbl Augenheilkd 2023. [PMID: 37224861 DOI: 10.1055/a-2069-2354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE To report a case of corneal perforation as a rare and late manifestation of choroidal melanoma and to highlight the major histopathological findings of this unusual combined clinical presentation. METHODS A 74-year-old male patient presented to our department due to corneal perforation of the right eye with the absence of light perception for 6 months. The intraocular pressure was hard on palpation. Because of the protracted finding and reduced visual prognosis, primary enucleation was performed. RESULTS The histopathological examination revealed choroidal melanoma with epithelioid and spindle cell components at the posterior pole, which was positive for Melan-A, Human Melanoma Black 45 (HMB45), BAP1, and SOX10. The anterior segment showed complete anterior chamber hemorrhage and blood remnants in the trabecular meshwork. The cornea displayed diffuse blood staining with hemosiderin and hemosiderin-loaded macrophages and keratocytes. No inflammatory cells were present near the corneal perforation, which had a width of 3 mm. Intraocular heterotopic ossification was indicative of a long-standing condition. Postoperative cancer staging was normal. CONCLUSION Corneal perforation should be considered as a very rare and late manifestation of advanced choroidal melanoma and may result from interaction between intraocular hemorrhage, elevated IOP, and its secondary signs such as corneal blood staining.
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Affiliation(s)
- Tim Berger
- Department of Ophthalmology, Saarland University Hospital (UKS), Homburg/Saar, Germany
| | - Fidelis Flockerzi
- Institute of General and Special Pathology, Saarland University Hospital (UKS), Homburg/Saar, Germany
| | - Ursula Löw
- Department of Ophthalmology, Saarland University Hospital (UKS), Homburg/Saar, Germany
| | - Elias Flockerzi
- Department of Ophthalmology, Saarland University Hospital (UKS), Homburg/Saar, Germany
| | - Wissam Aljundi
- Department of Ophthalmology, Saarland University Hospital (UKS), Homburg/Saar, Germany
| | - Alaadin Abdin
- Department of Ophthalmology, Saarland University Hospital (UKS), Homburg/Saar, Germany
| | - Loay Daas
- Department of Ophthalmology, Saarland University Hospital (UKS), Homburg/Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Hospital (UKS), Homburg/Saar, Germany
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Ando T, Seki M, Ueda E, Suetake A, Terashima H, Yoshida H, Hasebe H, Fukuchi T. A case of bilateral diffuse uveal melanocytic proliferation with secondary angle closure caused by ciliary body thickening. Am J Ophthalmol Case Rep 2022; 28:101729. [PMID: 36324629 PMCID: PMC9619173 DOI: 10.1016/j.ajoc.2022.101729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 08/28/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose To describe a case of bilateral diffuse uveal melanocytic proliferation (BDUMP) with secondary angle closure caused by ciliary body thickening accompanied by intraocular pressure (IOP) elevation after mydriasis. Observations A 55-year-old woman with a history of ovarian cancer had blurred vision in both eyes. Fundus examination revealed multiple patchy lesions in both eyes and a nevus-like elevated lesion in the right eye. Anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM) demonstrated angle closure resulting from ciliary body thickening. After mydriasis, the IOP was elevated in both eyes. Instillation of a miotic drug successfully reversed the IOP to normal levels. Conclusions and Importance BDUMP caused secondary angle closure in both eyes, presumably due to thickening of the entire ciliary body. AS-OCT and UBM were advantageous for analyzing the morphology of the anterior eye segment in BDUMP. Clinicians should be aware of the possibility of angle closure during the management of patients with BDUMP.
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Affiliation(s)
- Takumi Ando
- Department of Ophthalmology, Division of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan,Corresponding author.
| | - Masaaki Seki
- Department of Ophthalmology, Division of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan,Seki Eye Clinic, Niigata, Japan
| | - Eriko Ueda
- Department of Ophthalmology, Division of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Aki Suetake
- Department of Ophthalmology, Division of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Hiroko Terashima
- Department of Ophthalmology, Division of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Hiromitsu Yoshida
- Department of Ophthalmology, Division of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Hiruma Hasebe
- Department of Ophthalmology, Division of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan,Department of Ophthalmology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Takeo Fukuchi
- Department of Ophthalmology, Division of Ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
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Iris Ring Melanoma Presenting as Scleral Pigmentation. Case Rep Ophthalmol Med 2022; 2022:4840380. [PMID: 35832837 PMCID: PMC9273431 DOI: 10.1155/2022/4840380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 06/03/2022] [Accepted: 06/19/2022] [Indexed: 11/18/2022] Open
Abstract
To report a patient with a very rare variant of iris melanoma that grows in the shape of a ring (ring melanoma). A 65-year-old patient was examined because of a pigmented lesion on the sclera. After a complete ophthalmic and ultrasound examination, a ring melanoma was diagnosed. Enucleation of the affected eye was performed, and histology report confirmed iris ring melanoma. This type of malignancy represents an exceedingly rare variant of uveal melanoma, and because of atypical clinical picture, it can be easily overlooked or misdiagnosed, which often delays adequate treatment. Gonioscopy, transillumination, and ultrasound help us to recognize and diagnose ring melanoma. Suspicion should be raised with a clinical picture that shows unilateral pigmentary glaucoma. The objective of this presentation is to describe and outline the challenging diagnosis and management of this rare disease entity.
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Zhang X, Liu Y, Wang W, Chen S, Li F, Huang W, Aung T, Wang N. Why does acute primary angle closure happen? Potential risk factors for acute primary angle closure. Surv Ophthalmol 2017; 62:635-647. [DOI: 10.1016/j.survophthal.2017.04.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 04/04/2017] [Accepted: 04/10/2017] [Indexed: 12/14/2022]
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Stadigh A, Puska P, Vesti E, Ristimäki A, Turunen JA, Kivelä TT. Ring melanoma of the anterior chamber angle as a mimicker of pigmentary glaucoma. Surv Ophthalmol 2017; 62:670-676. [DOI: 10.1016/j.survophthal.2017.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 01/18/2017] [Accepted: 01/23/2017] [Indexed: 11/29/2022]
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Othman IS, Assem M, Zaki IMA. Secondary glaucoma as initial manifestation of uveal melanoma. Saudi J Ophthalmol 2013; 27:203-8. [PMID: 24227987 DOI: 10.1016/j.sjopt.2013.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Secondary glaucoma can be induced by a variety of local ocular problems. Intraocular tumors may initially present as secondary glaucoma. METHODS 8 consecutive patients with secondary glaucoma were found to have uveal melanoma. Thorough examination included detailed history, fundus examination with scleral depression, B scan ultrasonography, and CT/MRI scanning techniques. RESULTS A single case presented with spontaneous hyphema, two patients presented with secondary glaucoma, extraocular melanoma and metastases, a single case was found to have angle block by an iridociliary ring melanoma and 4 cases presented with neovascular glaucoma. Enucleation was necessary in all 8 cases. CONCLUSIONS General ophthalmologists should be aware of these rare initial manifestations of intraocular tumors as secondary glaucoma. Enucleation would be recommended in most cases of intraocular malignancy manifesting as secondary glaucoma. One should be extremely cautious in doing a penetrating surgery in such cases.
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Affiliation(s)
- Ihab Saad Othman
- Ophthalmology Departments, Cairo University, Cairo, Egypt ; EyeWorld Hospital, Giza, Egypt
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Diwo E, Merle H. [Ciliary body melanoma presenting as uveitis in a West Indian woman: Case report and review of the literature]. J Fr Ophtalmol 2013; 36:e191-5. [PMID: 24209784 DOI: 10.1016/j.jfo.2013.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 01/01/2013] [Accepted: 01/07/2013] [Indexed: 10/26/2022]
Abstract
The incidence of uveal melanoma, in particular that of the ciliary body, is very low in black people, including West Indians. When symptomatic, it manifests as decreased or impaired visual acuity and seldom, if ever, pain. We report a case of ciliary body melanoma that is of scientific interest for two reasons: 1) a West Indian melanoderm patient being affected, 2) presentation as a recurrent uveitis with a transient increase of intraocular pressure, and without any decline in visual acuity. We recommend that in any case of uveitis, black patients included, a ciliary body tumor should always be excluded by pupillary dilation.
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Affiliation(s)
- E Diwo
- Service d'ophtalmologie, centre hospitalier universitaire de Fort-de-France, hôpital Pierre-Zobda-Quitman, boîte postale 632, 97261 Fort-de-France cedex, Martinique.
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Abstract
A 52-year-old gentleman presented with 1-week history of severe right-sided headache associated with reduced vision in his right, amblyopic eye. Examination revealed raised intraocular pressure at 64 mm Hg. The anterior chamber (AC) was shallow and there was a dense cataract with no red reflex or fundal view. The contralateral eye had a deep anterior chamber with normal pressure and a clear lens. He was treated initially for acute angle closure glaucoma. The anterior chamber remained shallow and the intraocular pressure uncontrolled, despite maximum medical therapy. Owing to the absent fundal view and unilateral AC shallowing, further imaging was performed and a choroidal mass was found to be responsible for anterior displacement of the lens and shallowing of the angle. He went on to have an enucleation of the right eye, and histological examination confirmed the diagnosis of choroidal melanoma.
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Affiliation(s)
- Shi Zhuan Tan
- Department of Ophthalmology, Manchester Royal Eye Hospital, Manchester, UK.
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Abstract
Intraocular melanomas are not common entities but often lead to secondary glaucoma. Intraocular melanomas should be considered in the differential diagnosis of patients with unilateral glaucoma. Occasionally, the workup of unilateral glaucoma leads to a diagnosis of an intraocular melanoma. Intraocular melanomas represent the majority of intraocular tumors. The prevalence of intraocular melanomas as well as associated secondary glaucomas will be reviewed. The workup needed for unilateral glaucoma will be covered in detail. Treatment options for secondary glaucomas include topical and oral medications as well as argon laser trabeculoplasty and transscleral cyclophotocoagulation.
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Affiliation(s)
- Jason B Wanner
- Glaucoma Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
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Khetan V, Gupta K, Mohan ER, Gopal L. Uveal melanoma presenting as cataract and staphyloma. Indian J Ophthalmol 2009; 57:223-5. [PMID: 19384018 PMCID: PMC2683430 DOI: 10.4103/0301-4738.49398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Blind eyes can harbor a choroidal melanoma. We report a case of uveal melanoma presenting as staphyloma and complicated cataract in a 45-year-old female. The left eye was blind for six months. She underwent comprehensive ocular examination but fundus examination was precluded due to total cataract. The ultrasound of the eye showed a large mass filling the superior, nasal and inferonasal vitreous cavity with high surface reflectivity and low to moderate internal reflectivity. Magnetic resonance imaging (MRI) confirmed the diagnosis of choroidal melanoma. The patient underwent extended enucleation and histopathology was consistent with uveal melanoma.
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Affiliation(s)
- Vikas Khetan
- Department of Vitreoretina and Ocular Oncology, Medical Research Foundation, Sankara Nethralaya, Chennai, India.
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Pasternak S, Erwenne CM, Nicolela MT. Subconjunctival spread of ciliary body melanoma after glaucoma filtering surgery: a clinicopathological case report. Can J Ophthalmol 2005; 40:69-71. [PMID: 15825533 DOI: 10.1016/s0008-4182(05)80120-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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