1) A 60-year-old Asian male presented with loss of vision and severe headache in his right eye for 3 months. Examination revealed a large pigmented mass in the retrolental space, retinal detachment, and secondary glaucoma in the right eye. 2) Ultrasound and MRI confirmed a choroidal melanoma arising from the cilio-choroidal junction in the right eye, measuring over 1 cm3. 3) The patient underwent enucleation of the right eye. Histopathology revealed a Type A spindle cell melanoma with occasional mitoses and no scleral extension.

1. DR . SABITA KUMARI
GUIDED BY :
DR S.DAIGAVANE ,DR S.BANAIT
Case report : Chorodial Melanoma
with secondary glaucoma in asian
race.

2. INTRODUCTION :
 Choroidal melanoma is the commonest primary
intraocular tumor but is rare in the Indian population.
 Only three reports have been documented in India.
Its incidence in the world is 0.02–0.06%.
 The most common age group affected is between 40
and 60 years.
 It presents unilaterally and is slightly more frequent
in men.

3.  Blurred vision, pain, and floaters are common
symptoms, but it may be an incidental finding on
ophthalmoscopy.
 Secondary glaucoma is an uncommon presentation.
 Choroidal melanoma is rare in non-white races.
 Only two reports have been documented in India and
none presented with glaucoma (Manohar et al, 1991;
Biswaset al, 2000).

4. CASE REPORT:
A 60 years old male presented with loss of vision in right
eye and severe headache , associated with eyeache and
congestion in same eye since 3 months.
On examination, his visual acuity was No PL in the right eye
and 6/12 in the left eye; with pinhole 6/6.
Anterior segment examination
of right eye there was circum
corneal congestion .
A conjunctival naevus was
present near limbus .
Right eye pupil was fixed ,
dilated with a clear lens.

5. A darkly pigmented mass in
the retrolental space (supero-nasally)
and a detached retina were shown by
slit lamp examination.
Ocular examination of the left eye
was absolutely within normal limits.
The IOP in the right eye was
41.5mmHg; in the left eye it
was 14.6mmHg.
B-scan ultrasonography –
A large dome-shaped mass along
with retinal detachment.
Tumor has entered up to optic disc.

6.  The tumor mass was arising from cilio-choroidal
junction, diagnosed it as a case of choroidal melanoma.
 No metastasis was found on evaluation.
 MRI brain with contrast shows that there is e/o bilobed
cottage lesion of size 2 x 1.3cm seen arising from the
medial side of right orbit, lesion is hyperintense on T1 to
normal vitreous, hypointense on T2, and shows
enhancement.
 There is e/o complete tunnel Shaped retinal detachment
with subretinal haemorrhage.

7. Results: Enucleation of the eye
was subsequently performed.
Prosthtic eye (right eye) was
implanted.
Histologic sections showed
Type A, elongated spindle cells
with cytoplasm brown pigmentation.
Nucleus appeared to be compact
with Unremarkable mitotic activity.
The resected end
of the optic nerve
was also free of
tumor.

8. Discussion:
Though choroidal melanoma is the commonest primary
intraocular malignancy, it has a very low incidence, only 6
cases per million population /year, in the US. Moreover,
black patients have less than eight times the risk of
developing disease compared with white patients.
The ratio of white patients to dark skinned patients who
have this neoplasm is over 50:1, in most cases, the mean age
at diagnosis is about 55 years, and there is slight
preponderance of males (Seddon et al, 1989).

9. In a survey of 2,111 eyes in Philadelphia , it was found that
only 2% of the eyes with choroidal melanoma had secondary
glaucoma at the time of diagnosis. The commonest mechanism
in the cases of choroidal melanoma was neovascularization of
the iris (Shields et al, 1987).
The second most common mechanism of secondary glaucoma
is anterior displacement of the lens iris diaphragm by the
tumor mass, with the development of PAS and closed-angle
glaucoma (Spiereret al,1983; Shields et al, 1987): our case had
glaucoma caused by this mechanism.

10. The liver is the commonest site of metastasis.
The four important factors affecting the prognosis of
choroidal malignant melanoma are size, cell type, scleral
extension, and mitoticactivity (Yanoff and Fine, 1996).
Malignant melanomas over 1 cm3
have a poor prognosis.
Slightly less than 50% of ciliary body and choroidal
malignant melanomas are of the spindle cell variety. These
have a better prognosis than the non-spindle cell variety
(epithelial, mixed or necrotic).

11. In our patient the tumor measured more than 1 cm3
and
was of the spindle A type with occasional mitoses and no
scleral extension
Cases of primary choroidal malignant melanoma
presenting with secondary glaucoma in non white patients
are extremely rare.
This case is all the more interesting, given its rarity and its
unusual clinical presentation.