Iridocyclectomy for Ciliary Body Melanoma - Unique Approach and Surprising Result

Abstract

Introduction: We present a rare clinical case of ciliary body melanoma managed with eye-saving operation. Materials and Methods: A 50-year-old woman was diagnosed with increased IOP, very low visual acuity and cataract. On a visit for a second opinion a melanocytic lesion of the iris with a massive `sentinel` vascularization in the entire upper quadrant was noticed. Ultrasound investigation was very suggestive of ciliary body melanoma. The patient rejected the possibility of enucleation and after assessment of risk factors underwent an open-sky iridocyclectomy. She was left aphakic. After surgery, the patient had hemophthalmos for 20 days, after the absorption of which a zone of excised ciliary body was clearly visible on gonioscopy. Histology investigation confirmed the spindle-cell variant of the tumor and subsequent studies (PET scan), three months after surgery, rejected local and distant metastases. Second operation was performed in 6 months and a lens with artificial iris was sutured horizontally. Results: She is currently presenting with vision of 0.8, normal pressure, and unaffected other ocular structures. Conclusion: Ciliary body melanoma is a life-threatening condition that usually requires enucleation as a treatment of choice. In our case, by performing a novel surgery, we managed to preserve the patient`s eye and thereby provide good quality of life.