PMC9723233_01
Clinical course of the patient with choroidal melanoma. UWF, ultra-wide-field fundus photography; OCT, optical coherence tomography; FA, fluorescein angiography; ICGA, indocyanine green angiography; MRI, magnetic resonance imaging; PET-CT, positron emission tomography-computed tomography; SPECT, single-photon emission computed tomography; CFP, color fundus photography; BCVA, best-corrected visual acuity; LP, light perception; PPV, pars plana vitrectomy; ILM, internal limiting membrane.
fonc-12-1060307-g001.jpg
PMC9723233_01_fonc-12-1060307-g001.jpg
f1
The patient's clinical course is presented in  Figure 1 .
An 83-year-old man with choroidal melanoma. (A) Ultra-wide-field fundus photography revealed a white, elevated choroidal tumor with a central dark brown speckle (arrow) in the nasal quadrant and posterior vitreous detachment (arrowhead) inferior to the optic nerve. (B) Fluorescein angiography showed early hyperfluorescence corresponding to the mass. (C) Indocyanine green angiography showed blocked fluorescence and a small hyperfluorescent area at the edge. (D) Magnetic resonance imaging demonstrated a hyperintense tumor (arrow) with a smooth border on axial T1 imaging-fast spin-echo. (E) Iodine-123 isopropyl iodoamphetamine brain single-photon emission computed tomography showed high uptake in his left eye (arrow).
fonc-12-1060307-g002.jpg
PMC9723233_01_fonc-12-1060307-g002.jpg
f2
Figure 2A ) of the left eye revealed an elevated choroidal mass with a central dark brown speckle in the nasal quadrant, about 4 disc diameters from the optic disc, along with concomitant posterior vitreous detachment (PVD). Fluorescein angiography showed that the choroidal mass had early diffuse hyperfluorescence with a central area of hypofluorescence ( Figure 2B ). Indocyanine green angiography showed blocked fluorescence due to the choroidal mass and a small hyperfluorescent area at the margin in the late stage ( Figure 2C ). Magnetic resonance imaging demonstrated a tumor measuring 5.9x5.7 mm in basal dimensions and 4.1 mm thick, with a hyperintense signal toward the vitreous cavity on axial T1 imaging-fast spin-echo ( Figure 2D ). Iodine-123 isopropyl iodoamphetamine brain single-photon emission computed tomography revealed high focal uptake in his left eye, corresponding to the choroidal tumor ( Figure 2E ).
Fundus appearance in the patient with choroidal melanoma before and after vitrectomy. (A) Five months after radiotherapy, a full-thickness macular hole with cystic cavities was shown on optical coherence tomography. (B) A further 2 weeks later, a massive vitreous hemorrhage appeared on ultra-wide-field fundus photography. (C) The macular hole was successfully closed after pars plana vitrectomy with internal limiting membrane peeling.
fonc-12-1060307-g003.jpg
PMC9723233_01_fonc-12-1060307-g003.jpg
f3
Fundus examination and optical coherence tomography showed a full-thickness MH (stage 4) with cystic cavities ( Figure 3A ). Approximately 2 weeks later, his BCVA had decreased to 20/2000, attributed to an acute massive vitreous hemorrhage ( Figure 3B ). The MH remained closed after the two procedures ( Figure 3C ), the retina remained attached, the tumor displayed marked regression, and the BCVA had improved to 20/125.