Author: Sergio Matas Granados (Spain)
Co-authors: Wilfredo Menjívar Aguilar
Purpose
To report a case of a large choroidal melanoma that was diagnosed after cataract surgery and the subsequent treatment that was performed.
Setting/Venue
A 48-year-old male with white cataract in his left eye was programmed for a cataract surgery. The visual acuity was light perception (LP). The posterior pole cannot be evaluated because of the dense cataract. The surgery proceeded without complications and we implanted a monofocal intraocular lens.
Methods
Postoperatively, two months after surgery visual acuity was the same (LP) and we detected a complete retinal detachment and a large hypopigmented choroidal mass behind the intraocular lens. We requested nuclear magnetic resonance (NMR) imaging of the skull and orbits, and an eye ultrasound. Echography identified a 15-millimeters prominent lesion with low internal reflectivity on A-scan associated with exudative retinal detachment and pronounced tumor vascularization. In NMR, the mushroom-shaped lesion was hyperintense on T1 and hypointense on T2. The diagnosis of large amelanotic choroidal melanoma with Bruch’s membrane rupture and retinal detachment was made and an enucleation with implantation of 20-millimeters porous polyethylene prosthesis was performed 1 month later. During surgery, the four rectus muscles were sutured to the polyethylene prosthesis with non-absorbable suture. Also, we resected 10 millimeters of the optic nerve. The patient was treated with antibiotics and topical corticosteroids during the postoperative period.
Results
Histological examination confirmed the diagnosis of uveal melanoma (mixed cell-type) with a predominantly fusiform pattern located in postero-nasal choroid; 17-millimeters high and 15 millimeters in diameter that focally infiltrated the sclera without exceeding it and did not reach the ciliary body, iris or optic nerve. Immunohistochemistry showed HMB-45-positive, Melan-A-positive, CKAE1/AE3-negative, S100-negative and Ki-67 cell proliferation index of 5%. The tumor extension study was negative. Therefore, the tumor stage was T4a N0 M0. 3 months later, we prescribe the definitive prosthesis with a magnificent aesthetic result. The patient retained a relatively good mobility of the ocular prosthesis.
Conlusions
The preoperative evaluation of the posterior segment prior to cataract surgery is essential in order to identify any pathology like vascular retinal disease, age-related macular degeneration, etc. In case of a dense cataract, additional imaging such as ultrasound sonography is recommended in order to exclude intraocular lesions (retinal or choroidal detachments, tumors, etc). Thus, we can prevent unnecessary procedures, postoperative surprises and it allows a rough estimation of possible visual acuity following successful cataract surgery.
Financial Disclosure
NONE
Comments
-
