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87-year-old man was seen in the office on 2/7/2012. He noticed a new onset floater a few months ago. You saw a problem with the retina and suggested he come here for an evaluation. He is otherwise in excellent health. He does take aspirin daily. VISUAL ACUITY: Vision OD is 20/40, OS is 20/30. IOP: OD 13, OS 20. SLIT LAMP EXAM: There is 3+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. There is a posterior vitreous separation. There is a pigmented tumor in the temporal edge of the macula, just temporal to the macula extending out to the far periphery. There is also an inferior exudative retinal detachment. OS: Vertical C/D ratio is 0.1. There is a posterior vitreous separation. The macula and periphery look healthy. PHOTOGRAPHS: Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: FA shows a vascular tumor temporally with pigmentation typical for a choroidal melanoma. The photos of the left eye were normal. B-SCAN ECHOGRAPHY: B-scan ultrasound shows the base dimensions of the tumor to be 12.5 mm round and the elevation of the tumor on the A-scan is about 7.7 mm, but on the B-scan, which is slightly oblique, looked to be about 9.5 mm. I talked to radiation physics and we are going to go with about 9 mm for the height. IMPRESSION: 1. MEDIUM-SIZED CHOROIDAL MELANOMA WITH EXUDATIVE RETINAL DETACHMENT – RIGHT EYE 2. CATARACTS – BOTH EYES DISCUSSION: I explained to the patient he does have a choroidal melanoma in the right eye. It is in a reasonable place to treat with a radioactive plaque. It is relatively far from the macula and very far from the optic nerve.

choroidalmelanomaserousrd_thas01.jpg
Choroidal Melanoma (Medium) Exudative Retinal Detachment 167 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
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choroidalmelanomaserousrd_thas02.jpg
Choroidal Melanoma (Medium) Exudative Retinal Detachment 75 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
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choroidalmelanomaserousrd_thas03.jpg
Choroidal Melanoma (Medium) Exudative Retinal Detachment 99 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
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choroidalmelanomaserousrd_thas04.jpg
Choroidal Melanoma (Medium) Exudative Retinal Detachment 77 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
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choroidalmelanomaserousrd_thas05.jpg
Choroidal Melanoma (Medium) Exudative Retinal Detachment 108 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
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choroidalmelanomaserousrd_thas06.jpg
Choroidal Melanoma (Medium) Exudative Retinal Detachment 93 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
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choroidalmelanomaserousrd_thas07.jpg
Choroidal Melanoma (Medium) Exudative Retinal Detachment 66 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
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choroidalmelanomaserousrd_thas08.jpg
Choroidal Melanoma (Medium) Exudative Retinal Detachment 87 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
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choroidalmelanomaserousrd_thas09.jpg
Choroidal Melanoma (Medium) Exudative Retinal Detachment 94 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
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choroidalmelanomaserousrd_thas10.jpg
Choroidal Melanoma (Medium) Exudative Retinal Detachment 138 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
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choroidalmelanomaserousrd_thas11.jpg
Choroidal Melanoma (Medium) Exudative Retinal Detachment 78 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
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choroidalmelanomaserousrd_thas12.jpg
Choroidal Melanoma (Medium) Exudative Retinal Detachment 46 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
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choroidalmelanomaserousrd_thas13.jpg
Choroidal Melanoma (Medium) Exudative Retinal Detachment 68 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
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choroidalmelanomaserousrd_thas14.jpg
Choroidal Melanoma (Medium) Exudative Retinal Detachment 44 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
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choroidalmelanomaserousrd_thas15.jpg
Choroidal Melanoma (Medium) Exudative Retinal Detachment 53 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
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choroidalmelanomaserousrd_thas16.jpg
Choroidal Melanoma (Medium) Exudative Retinal Detachment 32 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
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choroidalmelanomaserousrd_thas17.jpg
Choroidal Melanoma (Medium) Exudative Retinal Detachment 40 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
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choroidalmelanomaserousrd_thas18.jpg
Choroidal Melanoma (Medium) Exudative Retinal Detachment 47 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
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choroidalmelanomaserousrd_thas19.jpg
Choroidal Melanoma (Medium) Exudative Retinal Detachment 50 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
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choroidalmelanomaserousrd_thas20.jpg
Choroidal Melanoma (Medium) Exudative Retinal Detachment 40 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
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choroidalmelanomaserousrd_thas21.jpg
Choroidal Melanoma (Medium) Exudative Retinal Detachment 45 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
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choroidalmelanomaserousrd_thas22.jpg
Choroidal Melanoma (Medium) Exudative Retinal Detachment 29 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
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choroidalmelanomaserousrd_thas23.jpg
Choroidal Melanoma (Medium) Exudative Retinal Detachment 62 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
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choroidalmelanomaserousrd_thas24.jpg
Choroidal Melanoma (Medium) Exudative Retinal Detachment 52 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
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choroidalmelanomaserousrd_thas25.jpg
Choroidal Melanoma (Medium) Exudative Retinal Detachment 64 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
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choroidalmelanomaserousrd_thas26.jpg
Choroidal Melanoma (Medium) Exudative Retinal Detachment 32 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
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choroidalmelanomaserousrd_thas27.jpg
Choroidal Melanoma (Medium) Exudative Retinal Detachment 35 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
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choroidalmelanomaserousrd_thas28.jpg
Choroidal Melanoma (Medium) Exudative Retinal Detachment 81 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
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choroidalmelanomaserousrd_thas29.jpg
Choroidal Melanoma (Medium) Exudative Retinal Detachment 76 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
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choroidalmelanomaserousrd_thas30.jpg
Choroidal Melanoma (Medium) Exudative Retinal Detachment 86 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
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choroidalmelanomaserousrd_thas31.jpg
Choroidal Melanoma (Medium) Exudative Retinal Detachment 104 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
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87-year-old man was seen in the office on 2/7/2012. He noticed a new onset floater a few months ago. You saw a problem with the retina and suggested he come here for an evaluation. He is otherwise in excellent health. He does take aspirin daily. VISUAL ACUITY: Vision OD is 20/40, OS is 20/30. IOP: OD 13, OS 20. SLIT LAMP EXAM: There is 3+ nuclear sclerosis in both eyes. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.1. There is a posterior vitreous separation. There is a pigmented tumor in the temporal edge of the macula, just temporal to the macula extending out to the far periphery. There is also an inferior exudative retinal detachment. OS: Vertical C/D ratio is 0.1. There is a posterior vitreous separation. The macula and periphery look healthy. PHOTOGRAPHS: Photos confirm clinical findings. FLUORESCEIN ANGIOGRAPHY: FA shows a vascular tumor temporally with pigmentation typical for a choroidal melanoma. The photos of the left eye were normal. B-SCAN ECHOGRAPHY: B-scan ultrasound shows the base dimensions of the tumor to be 12.5 mm round and the elevation of the tumor on the A-scan is about 7.7 mm, but on the B-scan, which is slightly oblique, looked to be about 9.5 mm. I talked to radiation physics and we are going to go with about 9 mm for the height. IMPRESSION: 1. MEDIUM-SIZED CHOROIDAL MELANOMA WITH EXUDATIVE RETINAL DETACHMENT – RIGHT EYE 2. CATARACTS – BOTH EYES DISCUSSION: I explained to the patient he does have a choroidal melanoma in the right eye. It is in a reasonable place to treat with a radioactive plaque. It is relatively far from the macula and very far from the optic nerve.