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Retinal Physician

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Ultra-Widefield Image of the Month

Simultaneous Rhegmatogenous Retinal Detachment and Choroidal Melanoma: A Rare Occurrence

By: Gabriel Velez, MD, PhD, Vinit B. Mahajan, MD, PhD, Prithvi Mruthyunjaya, MD, MHS
Retinal Physician November 1, 2024 Vol 21, Issue November/December 2024 Page(s): 6-7

Case Presentation

A 71-year-old female presented with progressively worsening vision in her left eye. Her exam and imaging demonstrated a medium-sized, peripapillary choroidal melanoma (CM) extending into the macula, and an associated rhegmatogenous retinal detachment (RRD) with inferior tears and proliferative vitreoretinopathy (PVR). The simultaneous occurrence of RRD and CM is rare, with less than 1% of CM co-presenting with RRD.1 RRD with choroidal elevation is more commonly caused by choroidal detachment (CD), including hemorrhagic CD. Thus, the diagnosis of CM in RRD patients is challenging, as the choroidal mass tends to be overlooked, resulting in delayed treatment. Our patient’s presentation demonstrates a unique challenge in terms of balancing the anatomic result with the visual outcome. Noting the risk of vision loss and anatomic risk to the eye with complex surgery and radiation, the patient elected to undergo primary enucleation for local tumor control.

The photograph shows an Optos optomap natural-color RGB fundus image. We can see a uniformly brown-colored peripapillary melanocytic choroidal lesion in the superior post-equatorial region and extending into the macula, with orange-colored lipofuscin on the surface consistent with a medium-sized choroidal melanoma. There is also a large RRD with inferior corrugations, surface folds from PVR, and two prominent inferior retinal tears.

Imaging Findings

The photograph shows an Optos optomap natural-color RGB fundus image. We can see a uniformly brown-colored peripapillary melanocytic choroidal lesion in the superior post-equatorial region and extending into the macula, with orange-colored lipofuscin on the surface consistent with a medium-sized choroidal melanoma. There is also a large RRD with inferior corrugations, surface folds from PVR, and two prominent inferior retinal tears. The optomap natural-color RGB fundus imaging permits detailed characterization of the choroidal lesion, along with visualization of the extent of the RRD and the causative breaks in relation to the location of the tumor. This is very helpful in diagnosis, treatment planning, patient education, and teaching our trainees about these complex ocular oncology cases.  

REFERENCES:

  1. Lakosha H, Simpson R, Wong D. Choroidal melanoma and rhegmatogenous retinal detachment. Can J Ophthalmol. 2000;35:151–153.

 

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