Melanoma - Medium Choroidal with Serous Retinal Detachment
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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.
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Choroidal Melanoma (Medium) Exudative Retinal Detachment 313 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/30
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Choroidal Melanoma (Medium) Exudative Retinal Detachment 404 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/30
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Choroidal Melanoma (Medium) Exudative Retinal Detachment 350 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/30
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Choroidal Melanoma (Medium) Exudative Retinal Detachment 439 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/30
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Choroidal Melanoma (Medium) Exudative Retinal Detachment 325 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/30
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Choroidal Melanoma (Medium) Exudative Retinal Detachment 277 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/30
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Choroidal Melanoma (Medium) Exudative Retinal Detachment 293 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/30
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Choroidal Melanoma (Medium) Exudative Retinal Detachment 307 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/30
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Choroidal Melanoma (Medium) Exudative Retinal Detachment 407 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/30
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Choroidal Melanoma (Medium) Exudative Retinal Detachment 348 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/30
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Choroidal Melanoma (Medium) Exudative Retinal Detachment 277 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/30
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Choroidal Melanoma (Medium) Exudative Retinal Detachment 318 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/30
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Choroidal Melanoma (Medium) Exudative Retinal Detachment 241 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/30
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Choroidal Melanoma (Medium) Exudative Retinal Detachment 273 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/30
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Choroidal Melanoma (Medium) Exudative Retinal Detachment 227 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/30
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Choroidal Melanoma (Medium) Exudative Retinal Detachment 235 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/30
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Choroidal Melanoma (Medium) Exudative Retinal Detachment 244 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/30
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Choroidal Melanoma (Medium) Exudative Retinal Detachment 278 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/30
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Choroidal Melanoma (Medium) Exudative Retinal Detachment 229 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/30
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Choroidal Melanoma (Medium) Exudative Retinal Detachment 238 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/30
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Choroidal Melanoma (Medium) Exudative Retinal Detachment 231 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/30
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Choroidal Melanoma (Medium) Exudative Retinal Detachment 245 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/30
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Choroidal Melanoma (Medium) Exudative Retinal Detachment 256 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/30
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Choroidal Melanoma (Medium) Exudative Retinal Detachment 252 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/30
(0 votes)
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Choroidal Melanoma (Medium) Exudative Retinal Detachment 231 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/30
(0 votes)
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Choroidal Melanoma (Medium) Exudative Retinal Detachment 222 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/30
(0 votes)
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Choroidal Melanoma (Medium) Exudative Retinal Detachment 273 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/30
(0 votes)
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Choroidal Melanoma (Medium) Exudative Retinal Detachment 275 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/30
(0 votes)
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Choroidal Melanoma (Medium) Exudative Retinal Detachment 288 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/30
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Choroidal Melanoma (Medium) Exudative Retinal Detachment 338 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/30
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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.
