Melanoma - Choroidal Medium - Macular
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65-year-old man noticed a vision change a few days ago in the left eye.
VISUAL ACUITY: OD 20/20, OS 20/63. IOP: OD 14, OS 12.
SLIT EXAMINATION: The posterior chamber intraocular lens is in good position in both eyes. The right eye has 1+ posterior capsular opacity. The left eye has a 2+ posterior capsular opacity.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.2. There is a 2+ epiretinal membrane.
OS: Vertical C/D ratio is 0.2. There is a posterior vitreous separation. There is a pigmented lesion inferotemporal to the macula, which unfortunately does touch the fovea. It is about 9x8 millimeters high in appearance.
SPECTRALIS-SD-OCT SCAN: The photos in the right eye show the epiretinal membrane and in the left eye there is a choroidal mass. The right eye shows a partial vitreous separation with some epiretinal membrane.
The left eye shows a serous retinal detachment associated with the elevated choroidal lesion.
FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography of the left eye shows early hypofluorescence and hyperfluorescence around the area of the choroidal mass in the left eye with filling of what looks to be its own vasculature. In the later frames of the angiogram, there is a rim of hypofluorescence around it, where there is mottled pigment and then some hyperfluorescence within the lesion. The lesion does appear to have two components, one of which is a circular area in the center and then a more diffuse area around the periphery.
The right eye shows a normal fill with no evidence of any macular lesions.
INDOCYANINE GREEN ANGIOGRAPHY: Indocyanine green angiogram of the left eye was obtained, which does show hypofluorescence in the area of the lesion. There do appear to be some vessels within the lesion, but only minimally.
B-SCAN ECOGRAPHY: B-scan ecography of the ultrasound of the left eye shows a dome-shaped lesion, which is 9x9 millimeters with low internal reflectivity.
A-SCAN ECOGRAPHY: The A-scan confirms low internal reflectivity with a height of 4 millimeters at the peak on the lesion.
IMPRESSION:
1. MEDIUM CHOROIDAL MELANOMA – LEFT EYE
2. POSTERIOR CAPSULAR OPACITY – BOTH EYES
3. EPIRETINAL MEMBRANE – RIGHT EYE
DISCUSSION: I explained to the patient he does have a choroidal melanoma in the left eye. Given the size of the lesion, it is reasonable to consider brachytherapy for this with a radioactive plaque. External beam therapy was previous and only available in Boston, but now it is available at a few places around the country, one of which is Gainesville.
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65-year-old man noticed a vision change a few days ago in the left eye.
VISUAL ACUITY: OD 20/20, OS 20/63. IOP: OD 14, OS 12.
SLIT EXAMINATION: The posterior chamber intraocular lens is in good position in both eyes. The right eye has 1+ posterior capsular opacity. The left eye has a 2+ posterior capsular opacity.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.2. There is a 2+ epiretinal membrane.
OS: Vertical C/D ratio is 0.2. There is a posterior vitreous separation. There is a pigmented lesion inferotemporal to the macula, which unfortunately does touch the fovea. It is about 9x8 millimeters high in appearance.
SPECTRALIS-SD-OCT SCAN: The photos in the right eye show the epiretinal membrane and in the left eye there is a choroidal mass. The right eye shows a partial vitreous separation with some epiretinal membrane.
The left eye shows a serous retinal detachment associated with the elevated choroidal lesion.
FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography of the left eye shows early hypofluorescence and hyperfluorescence around the area of the choroidal mass in the left eye with filling of what looks to be its own vasculature. In the later frames of the angiogram, there is a rim of hypofluorescence around it, where there is mottled pigment and then some hyperfluorescence within the lesion. The lesion does appear to have two components, one of which is a circular area in the center and then a more diffuse area around the periphery.
The right eye shows a normal fill with no evidence of any macular lesions.
INDOCYANINE GREEN ANGIOGRAPHY: Indocyanine green angiogram of the left eye was obtained, which does show hypofluorescence in the area of the lesion. There do appear to be some vessels within the lesion, but only minimally.
B-SCAN ECOGRAPHY: B-scan ecography of the ultrasound of the left eye shows a dome-shaped lesion, which is 9x9 millimeters with low internal reflectivity.
A-SCAN ECOGRAPHY: The A-scan confirms low internal reflectivity with a height of 4 millimeters at the peak on the lesion.
IMPRESSION:
1. MEDIUM CHOROIDAL MELANOMA – LEFT EYE
2. POSTERIOR CAPSULAR OPACITY – BOTH EYES
3. EPIRETINAL MEMBRANE – RIGHT EYE
DISCUSSION: I explained to the patient he does have a choroidal melanoma in the left eye. Given the size of the lesion, it is reasonable to consider brachytherapy for this with a radioactive plaque. External beam therapy was previous and only available in Boston, but now it is available at a few places around the country, one of which is Gainesville.
