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69-year-old man was seen on January 17, 2008. He has had heart problems lately with a heart attack and he had a cardiac arrest on the gold course. He had triple bypass surgery in June of 2007. He was doing well but then he noticed a vision problem in the left eye starting three weeks ago. He started losing side vision. VISUAL ACUITY: Vision OD 20/40. Pinhole 20/30. Vision OS 20/50. IOP: OD 12, OS 13. SLIT LAMP EXAM: The right eye has 1+ nuclear sclerosis. In the left eye there are sentinel vessels in the conjunctiva at 2 o’clock and 3 o’clock, feeding brown lesions which are just posterior to the corneal- scleral limbus. They are each about 2 mm across and slightly elevated. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. The macula looks healthy. The left eye has a hazy view of the fundus because of the brown lesion in the ciliary body, which is obscuring much of the fundus. It looks to be a melanoma, which extends from 12 o’clock around to 8 o’clock. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: FA was done, which shows a blood supply to the surface of the tumor and then an ultrasound was done, which shows a large melanoma virtually filling the eye. The scan gives it an elevation of 13 mm around the periphery it is immeasurable. Its diameter would be about 40 mm. IMPRESSION: 1. CILIARY BODY RING MELANOMA WITH EXTRAOCULAR EXTENSION – LEFT EYE DISCUSSION: I explained to the patient that unfortunately he does have a large melanoma in the left eye. The only treatment for this is enucleation which I recommend we do in the near future. He is on Plavix. I asked him to stop the Plavix and we will do it sometime within the next few weeks.

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Melanoma - Large Ciliary Body B Scan Ultrasound160 views00000
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Melanoma - Large Ciliary Body Photo shows tumor visible through the pupil357 views00000
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Melanoma - Large Ciliary Body Photo shows tumor visible throught the pupil226 views55555
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Melanoma - Large Ciliary Body B-Scan ultrasound shows tumore filling much of the eye265 views00000
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Melanoma - Large Ciliary Body A scan shows medium to low internal reflectivity179 views44444
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69-year-old man was seen on January 17, 2008. He has had heart problems lately with a heart attack and he had a cardiac arrest on the gold course. He had triple bypass surgery in June of 2007. He was doing well but then he noticed a vision problem in the left eye starting three weeks ago. He started losing side vision. VISUAL ACUITY: Vision OD 20/40. Pinhole 20/30. Vision OS 20/50. IOP: OD 12, OS 13. SLIT LAMP EXAM: The right eye has 1+ nuclear sclerosis. In the left eye there are sentinel vessels in the conjunctiva at 2 o’clock and 3 o’clock, feeding brown lesions which are just posterior to the corneal- scleral limbus. They are each about 2 mm across and slightly elevated. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. The macula looks healthy. The left eye has a hazy view of the fundus because of the brown lesion in the ciliary body, which is obscuring much of the fundus. It looks to be a melanoma, which extends from 12 o’clock around to 8 o’clock. Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: FA was done, which shows a blood supply to the surface of the tumor and then an ultrasound was done, which shows a large melanoma virtually filling the eye. The scan gives it an elevation of 13 mm around the periphery it is immeasurable. Its diameter would be about 40 mm. IMPRESSION: 1. CILIARY BODY RING MELANOMA WITH EXTRAOCULAR EXTENSION – LEFT EYE DISCUSSION: I explained to the patient that unfortunately he does have a large melanoma in the left eye. The only treatment for this is enucleation which I recommend we do in the near future. He is on Plavix. I asked him to stop the Plavix and we will do it sometime within the next few weeks.