Eviscerated eyes unexpectedly containing uveal melanoma

Abstract

AbstractPurpose To present two cases with eviscerated eyes containing uveal melanoma and review the literatureMethods All the evisceration specimens from a 15 year period were analyzed for malignancies. A literature search on the accidental finding of intraocular malignancy after evisceration was performedResults We found an incidence of intraocular malignant melanoma of 0.7% (2/315). In these 2 cases, a standard evisceration procedure with implantation of an acrylic ball had been performed for pain in a longstanding blind eye with opaque media. Both patients had a history of glaucoma and massive intraocular hemorrhage, confirmed by repetitive ocular ultrasound (US) and orbital CT. Histopathology showed a large intraocular uveal melanoma with substantial necrosis and haemorrhage After negative screening for metastases, one week following the evisceration an enucleation of the scleral shell and implant was performed, with implantation of a new acrylic ball with donor sclera. External beam radiation of 5,000 cGy was given to the orbital socket. The first patient died from liver metastases 3 years after the diagnosis, without evidence of local recurrence. The second patient has a too short follow‐up The literature is scarce on this subject, with only 9 published cases. US is the mainstay in the screening for intraocular tumors in opaque eyes. There are no guidelines on the management after accidental evisceration of uveal melanomaConclusion Ultrasound can not always distinguish primary choroidal hemorrhage from secondary hemorrhage due to uveal melanoma with necrosis. An atypical clinical history of a blind painful opaque eye with prolonged massive intraocular hemorrhage and ocular hypertension may be suspect for malignant melanoma, in which case evisceration should be avoided