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Original Investigation | Clinical Sciences

The Occurrence and Proposed Significance of Schnabel Cavernous Degeneration in Uveal Melanoma

Mozhgan Rezaei Kanavi, MD1,2; Amir A. Azari, MD1; Heather D. Potter, MD1; Vivian Lee, MD1; Daniel M. Albert, MD1
[+] Author Affiliations
1Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison
2Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
JAMA Ophthalmol. 2014;132(5):600-604. doi:10.1001/jamaophthalmol.2013.8182.
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Importance  Schnabel cavernous degeneration (SCD) has been observed in eyes with uveal melanoma (UM), but, to our knowledge, a definitive study establishing the association between SCD and UM has not been conducted.

Objective  To explore an association between SCD and UM.

Design, Setting, and Participants  A historical cohort analysis was performed using histologic slides and related clinical records of cases from the Collaborative Ocular Melanoma Study and Eye Pathology Laboratory at the University of Wisconsin, including 1985 UM eyes, 517 eye bank eyes, and 155 enucleated glaucomatous eyes.

Main Outcomes and Measures  The prevalence of SCD was calculated and compared between each group; subgroup analysis was also conducted of eyes with and without SCD for the prevalence of glaucoma.

Results  Schnabel cavernous degeneration was seen in 17 (0.9%) UM eyes, 9 (1.7%) eye bank eyes, and 2 (1.3%) enucleated glaucomatous eyes. No difference was detected between the prevalence of SCD in UM eyes and eye bank eyes (odds ratio [OR], 0.49; 95% CI, 0.22-1.10) or enucleated glaucomatous eyes (OR, 0.66; 95% CI, 0.15-2.89). Subgroup analysis, performed on 421 UM eyes, provided sufficient clinical information to definitively establish the presence or absence of glaucoma. Of the 95 (22.6%) eyes with glaucoma, 11 (11.6%) revealed histopathologic evidence of SCD. Compared with enucleated end-stage glaucoma eyes, this represents a 10-fold increase in SCD in UM eyes with glaucoma (OR, 10.10; 95% CI, 2.17-46.26). The prevalence of glaucoma in UM eyes with SCD, however, was respectively 7- and 15-fold higher than the prevalence of glaucoma in SCD-negative UM eyes (OR, 6.98; 95% CI, 2.51-19.43) and SCD-positive eye bank eyes (OR, 14.67; 95% CI, 1.46-146.97).

Conclusions and Relevance  Although an association between SCD and UM was not confirmed, subgroup analysis did reveal an increased incidence of SCD in eyes with both UM and glaucoma. This suggests that the occurrence of glaucoma may increase the risk of SCD in eyes with UM.

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Figure.
Schnabel Cavernous Degeneration of the Retrolaminar Optic Nerve

Uveal melanoma exhibiting spongiform changes (arrowheads) and containing acid mucopolysaccharide material (A) on Alcian blue staining (B).

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