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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 567 views87-year-old man noticed a new onset floater a few months ago. OD is 20/40, OS is 20/3000000
(0 votes)
choroidalmelanomaserousrd_thas02.jpg
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 20/3000000
(0 votes)
choroidalmelanomaserousrd_thas03.jpg
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 20/3000000
(0 votes)
choroidalmelanomaserousrd_thas04.jpg
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 20/3000000
(0 votes)
choroidalmelanomaserousrd_thas05.jpg
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 20/3000000
(0 votes)
choroidalmelanomaserousrd_thas06.jpg
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 20/3000000
(0 votes)
choroidalmelanomaserousrd_thas07.jpg
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 20/3000000
(0 votes)
choroidalmelanomaserousrd_thas08.jpg
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 20/3000000
(0 votes)
choroidalmelanomaserousrd_thas09.jpg
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 20/3000000
(0 votes)
choroidalmelanomaserousrd_thas10.jpg
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 20/3000000
(0 votes)
choroidalmelanomaserousrd_thas11.jpg
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 20/3000000
(0 votes)
choroidalmelanomaserousrd_thas12.jpg
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 20/3000000
(0 votes)
choroidalmelanomaserousrd_thas13.jpg
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 20/3000000
(0 votes)
choroidalmelanomaserousrd_thas14.jpg
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 20/3000000
(0 votes)
choroidalmelanomaserousrd_thas15.jpg
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 20/3000000
(0 votes)
choroidalmelanomaserousrd_thas16.jpg
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 20/3000000
(0 votes)
choroidalmelanomaserousrd_thas17.jpg
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 20/3000000
(0 votes)
choroidalmelanomaserousrd_thas18.jpg
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 20/3000000
(0 votes)
choroidalmelanomaserousrd_thas19.jpg
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 20/3000000
(0 votes)
choroidalmelanomaserousrd_thas20.jpg
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 20/3000000
(0 votes)
choroidalmelanomaserousrd_thas21.jpg
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 20/3000000
(0 votes)
choroidalmelanomaserousrd_thas22.jpg
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 20/3000000
(0 votes)
choroidalmelanomaserousrd_thas23.jpg
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 20/3000000
(0 votes)
choroidalmelanomaserousrd_thas24.jpg
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 20/3000000
(0 votes)
choroidalmelanomaserousrd_thas25.jpg
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 20/3000000
(0 votes)
choroidalmelanomaserousrd_thas26.jpg
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 20/3000000
(0 votes)
choroidalmelanomaserousrd_thas27.jpg
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 20/3000000
(0 votes)
choroidalmelanomaserousrd_thas28.jpg
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 20/3000000
(0 votes)
choroidalmelanomaserousrd_thas29.jpg
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 20/3000000
(0 votes)
choroidalmelanomaserousrd_thas30.jpg
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 20/3000000
(0 votes)
choroidalmelanomaserousrd_thas31.jpg
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 20/3000000
(0 votes)
 
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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.