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Optic Disc Edema From Remote Uveal Melanoma

Sireesha A. Clark, MD; Martin Lubow, MD; Abhik Ray-Chaudhury, MD; Frederick H. Davidorf, MD; Mohamed H. Abdel-Rahman, MD, PhD; Colleen M. Cebulla, MD, PhD
JAMA Ophthalmol. 2013;131(1):115-117. doi:10.1001/jamaophthalmol.2013.575.
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Uveal melanoma is associated with local ocular effects including retinal detachment and macular edema,1 but few reports detail the remote effects on the optic nerve. Two cases of optic nerve head leakage on angiography are reported in patients with uveal melanoma.2 These cases had melanoma cells adjacent to or in the optic nerve, and the changes were attributed to direct effects of the tumor. We describe a patient with uveal melanoma, remote from the optic nerve, who showed optic disc fluorescein leakage despite no direct tumor association on histopathologic analysis.

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Figure 1. Fundus photograph, B-scan ultrasonography, and fluorescein angiography. A, Fundus photograph of the left eye shows ciliochoroidal melanoma remote from the optic nerve. B, B-scan ultrasonography of the left eye reveals a choroidal mass remote from the optic nerve and inferior retinal detachment. C, Late fluorescein angiographic image reveals no leakage from the right eye. D, Late fluorescein angiographic image shows optic disc leakage from the left eye.

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Figure 2. Magnetic resonance image and histopathologic analysis. A, Axial T1-weighted magnetic resonance image demonstrates that the ciliochoroidal tumor of the left globe is remote from the optic nerve. Inset, Transverse section of the left optic nerve (from the area of the box in the magnetic resonance image) with no evidence of tumor invasion (original magnification ×200). B, Ciliochoroidal melanoma (hematoxylin-eosin, original magnification ×100). Inset, Epithelioid cells (hematoxylin-eosin, original magnification ×400).

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