Uveal Melanoma and Secondary Angle-Closure Crisis: A Case Report and Literature Review

A 66-years-old Vietnamese healthy female patient presented with prolonged severe right ocular pain and complete vision loss in that eye. Anterior segment assessment including gonioscopy identified angle-closure configuration. A suspected ciliary body melanoma was seen through the pupil. Posterior segment examination revealed a large tumor mass and 360° retinal detachment (kissing configuration). An ultrasound examination was consistent with a uveal tumor. The painful, blind right eye with a tumor mass was enucleated. Histopathology confirmed a type A uveal spindle cell melanoma associated with total serous retinal detachment without evidence of tumor necrosis, epithelioid cells, scleral, or optic nerve infiltration. There was no evidence of metastasis after 1-year of follow-up. It is critically important to differentiate primary and secondary angle closure, especially in cases with life-threatening ocular malignancy as uveal melanoma.

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Uveal Melanoma Identified as Ocular Mass on Point-of-care Ultrasound

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2021.4.52115 ◽

2021 ◽

Vol 5 (3) ◽

pp. 367-368

Author(s):

Hannah Spungen ◽

Daniel Weingrow

Keyword(s):

Emergency Department ◽

Retinal Detachment ◽

Uveal Melanoma ◽

Vision Loss ◽

Point Of Care ◽

Black Spot ◽

Distant Metastases ◽

Posterior Chamber ◽

Point Of Care Ultrasound ◽

Point Of Care Ultrasonography

Case Presentation: A 41-year-old man presented to the emergency department with five months of progressive monocular vision loss in his right eye, which he described as a gradually descending and enlarging black spot. He had no light perception in his right eye with elevated intraocular pressure and an afferent pupillary defect, while his left eye visual acuity and pupillary exam was normal. Point-of-care ultrasound demonstrated a hyperechoic, pedunculated mass in the posterior chamber of his right eye, consistent with a diagnosis of ocular melanoma. Ophthalmology scheduled the patient for an elective, right eye enucleation the following week, after which a diagnosis of uveal melanoma (UM) was confirmed on histopathology. Discussion: Uveal melanoma is an uncommon diagnosis that requires prompt intervention and surveillance due to the possibility of distant metastases arising in up to 50% of patients. Emergency department diagnosis of UM may be confounded by features of other intraocular pathology, such as increased ocular pressure or the finding of retinal detachment on fundoscopy. When emergency providers encounter glaucoma or retinal detachment on physical exam, point-of-care ultrasonography represents a key adjunct in the timely diagnosis and referral of this potentially vision- and life-threatening malignancy.

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Refractory Myopic Retinal Detachment and Macular Hole Closure with Autologous Neurosensory Retinal Free Flap

Case Reports in Ophthalmology ◽

10.1159/000500275 ◽

2019 ◽

Vol 10 (2) ◽

pp. 160-164 ◽

Cited By ~ 1

Author(s):

Filipe Sousa Neves ◽

Joana Braga ◽

Paula Sepúlveda ◽

Miguel Bilhoto

Keyword(s):

Retinal Detachment ◽

Macular Hole ◽

Free Flap ◽

Vision Loss ◽

Silicone Oil ◽

Modified Technique ◽

Alternative Approach ◽

Retinal Atrophy ◽

One Year ◽

Hole Closure

The purpose of this case report is to describe a modified technique involving the use of an autologous neurosensory retinal free flap for closure of a macular hole (MH) during retinal detachment (RD) surgery. A 50-year-old female presented with sudden vision loss (light perception only) and a recurrent myopic RD associated with an MH. An autologous neurosensory retinal free flap was obtained and moved toward the MH. Silicone oil was used as an endotamponade and removed after 6 months. Two months after oil removal visual acuity improved to 20/400 and remained stable thereafter; however, the patient developed central retinal atrophy. One year after surgery the MH was closed and the retina attached. This modified technique with the use of an autologous neurosensory retinal flap provides an alternative approach for recurrent MH in RD procedures.

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Etiologies and clinical characteristics of young patients with angle-closure glaucoma: a 15-year single-center retrospective study

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-021-05172-6 ◽

2021 ◽

Author(s):

Feng Gao ◽

Jiajian Wang ◽

Junyi Chen ◽

Xiaolei Wang ◽

Yuhong Chen ◽

...

Keyword(s):

Clinical Characteristics ◽

Anterior Segment ◽

Young Patients ◽

Case Series ◽

Neovascular Glaucoma ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Primary Angle Closure Glaucoma ◽

Uncommon Presentation ◽

Underlying Causes

Abstract Purpose To investigate the etiologies and the clinical characteristics of angle-closure glaucoma (ACG) patients younger than 40 years old in Chinese. Methods Inpatients with diagnosis of ACG and diagnosed age younger than or equal to 40 years old, who were admitted in Eye, Ear, Nose, and Throat Hospital Fudan University from 2002 to 2017, were included in this retrospective non-comparative case series. The underlying causes and clinical features for all the patients were analyzed by comprehensive review of medical charts. Results A total of 298 patients (463 eyes) met the criteria, including 153 females (51.3%) and 145 males (48.7%); the mean age was 25.6 ± 13.0 years. Primary angle-closure glaucoma (PACG), uveitis, and anterior segment dysgenesis (ASD) were the top three etiologies in our patients, which accounted for 32.6%, 20.3%, and 15.1% of the total patients respectively. PACG mainly occurs after 30 years of age and ASD is the top reason of ACG in patients younger than 20 years old. Other known etiologies include iridocorneal endothelial syndrome, neovascular glaucoma, nanophthalmos, retinitis pigmentosa, spherophakia, bestrophinopathy, persistent fetal vasculature, iridociliary cysts, congenital retinoschisis, Marfan’s syndrome, retinopathy of prematurity, familial exudative vitreoretinopathy, congenital retinal folds, Coat’s disease, and neurofibromatosis. Conclusions We described the uncommon presentation of ACG in Chinese young patients. Although unusual, most of the etiologies could be identified. Therefore, more careful and comprehensive examinations are needed for early detection and timely treatment for young ACG patients.

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The Use of Anterior-Segment Optical-Coherence Tomography for the Assessment of the Iridocorneal Angle and Its Alterations: Update and Current Evidence

Journal of Clinical Medicine ◽

10.3390/jcm10020231 ◽

2021 ◽

Vol 10 (2) ◽

pp. 231

Author(s):

Giacinto Triolo ◽

Piero Barboni ◽

Giacomo Savini ◽

Francesco De Gaetano ◽

Gaspare Monaco ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Intraocular Pressure ◽

Clinical Relevance ◽

Anterior Segment ◽

Angle Closure ◽

Current Evidence ◽

Optical Coherence ◽

Iridocorneal Angle ◽

Wide Range

The introduction of anterior-segment optical-coherence tomography (AS-OCT) has led to improved assessments of the anatomy of the iridocorneal-angle and diagnoses of several mechanisms of angle closure which often result in raised intraocular pressure (IOP). Continuous advancements in AS-OCT technology and software, along with an extensive research in the field, have resulted in a wide range of possible parameters that may be used to diagnose and follow up on patients with this spectrum of diseases. However, the clinical relevance of such variables needs to be explored thoroughly. The aim of the present review is to summarize the current evidence supporting the use of AS-OCT for the diagnosis and follow-up of several iridocorneal-angle and anterior-chamber alterations, focusing on the advantages and downsides of this technology.

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