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 419 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 223 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 275 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 253 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 314 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 233 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 193 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 209 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 221 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 260 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 186 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 222 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 154 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 184 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 135 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 143 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 157 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 193 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 143 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 152 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 141 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 160 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 169 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 169 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 140 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 136 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 188 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 191 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 201 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 234 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.
