Rhegmatogenous retinal detachment in choroidal melanoma

Author: Rodrigo Anguita (United Kingdom)

Co-authors: Mohammed Katta, Minak Bhalla, Mandeep Sagoo, David Charteris

Purpose

To ascertain demographic, clinical features, prognostic factors, safety, rate of success of surgery and visual outcomes in patients with rhegmatogenous retinal detachment (RD) and choroidal melanoma (CM)

Setting/Venue

Moorfields Eye Hospital NHS Foundation Trust, London, UK

Methods

A retrospective, observational case-series of 20 patients with rhegmatogenous retinal detachment or combined tractional-rhegmatogenous retinal detachment in patients with choroidal melanoma over a period of 20 years (2002-2020)

Results

There were 18 patients of age (mean+SD) 61.3 (13.9) years included in the final analysis. CM location was mid-periphery in 10 eyes and posterior pole in 8 eyes (mean tumour elevation 4.0 (1.7) mm; largest diameter 11.0 (2.4) mm. In 14 eyes the RD was rhegmatogenous and in 4 eyes combined rhegmatogenous/tractional. The timing of the RD occurred after the CM treatment in 14 eyes at mean interval of 44.2 (58.3) months; concurrent with the CM in 2 eyes, found during RD surgery, and in 1 eye suspicious melanocytic lesion before surgery was later confirmed as CM. 2 eyes had previous tumour biopsy for diagnosis or cytogenetic testing. Other features were macula-on RD in 6 eyes, PVD in 12 eyes and PVR in 6 eyes (100% PVR-C). RD repair was by vitrectomy in 15 eyes, and 1 each of barrier laser, scleral buckle and observation. Silicone oil was used in 8 eyes and gas in 7 eyes. LogMAR BCVA at presentation was 0.6 and final BCVA was 1.5 (P=0.003). Final retinal status was retina attached in 14 eyes (9 under oil) and detached in 4 eyes (3 under oil and 1 no surgery). No intraocular or extraocular tumour dissemination occurred

Conlusions

Retinal detachment in patients with choroidal melanoma is uncommon but requires multidisciplinary management. Anatomical results are favourable but visual outcomes are poor due to a combination of factors related with melanoma treatment as well as retinal detachment. Vitrectomy as a surgical intervention for RD appears to be safe in terms tumour dissemination.

Financial Disclosure

N/A

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