Interactive Case Reports

Sectoral cataract as presentation form of a ciliary body melanoma

Case Report Details

First Author: C.Fernandes PORTUGAL

Co Author(s):    C. Bruxelas   P. Silva   M. Patrício   M. Guedes   P. Simões        

Abstract Details

Purpose:

To report a case of a sectoral cataract as presentation form of a ciliary body melanoma.

Setting:

Tertiary University Hospital: Hospital de Egas Moniz (C.H.L.O.) Lisbon, Emergency department.

Report of Case:

The authors report a case of a sixty-one years old woman, healthy, with no ocular or systemic disease, history of trauma, ophthalmic surgery, or chronic medication, that occasionally discovers painless visual loss in the left eye (LE), without visual complains in the right eye (RE). She was admitted to the emergency department, her best corrected visual acuity (BCVA) in the RE was 10/10 and in the LE was 3/10. Slit-lamp examination of RE anterior and posterior segment was normal, in the LE we documented a focal lens opacity, in the inferior-nasal quadrant. Pupillary light reactions were normal. Intraocular pressure measured by applanation tonometry was 16 mmHg in both eyes. The patient was submitted to an ultrasound biomicroscopy (UBM) that showed a retro-iridian mass, mainly solid but also with a cystic component, between 6-9 o’clock, conditioning a sectoral cataract. She undertook systemic evaluation; no other lesions were detected. This patient was submitted to brachytherapy and excisional biopsy that confirm the diagnosis of ciliary body melanoma. After this she was submitted to left eye phacoemulsification with intra-ocular lens implantation. At one-year follow-up the patient remains stable, with no signs of metastatic disease with BCVA in LE 2/10.

Conclusion/Take Home Message:

Melanoma is a relatively rare tumor arising from melanocytes located at various locations including the eye (uvea, conjunctiva, eyelid, orbit). Here they can go unnoticed by the patient and they often follow an asymptomatic course until they grow large enough to affect central vision. UBM provides detailed cross-sectional images of the anterior segment, including iris and ciliary body, even in the presence of media opacities. Thus, UBM is extremely important for early diagnosis, as we think that occurred in our case report, contributing to sight saving and lifesaving.

Financial Disclosure:

None