RARE CASE OF CHORIODAL MELANOMA PRESENTING AS A CONGESTIVE GLAUCOMA LE

PRESENTATATION OF A RARE CASE RSRE SND INTERESTING CASE OF CHORIODAL MELANOMA PRESENTING AS A CASE OF A CONGESTIVE GLAUCOMA LEFT EYE IN A 55 YESRS OLD MALE PATIENT ABASTRACT CHORIODAL MELANOMAS ARE ONE OF TGE COMMONEST INTRAOCULAR TUMOURS THEY CAN BE BENIGN MSLIGNANT PIGMENTED NON PIENTED MORE COMMON IN WHITES THAN BLACKS HAVE HOT AN EARLY TENDENCY FOR LIVER METASTASES HOWEVER IF DIAGNOSED AND TREATED PROPERLY AND EARLY NONE CAN PREVENT LIVER METASTASES THEY SRE 6 PER MILLION IN U SCA 7.5 PER MILLION IN DENMARK AND OTHER SCANDENEVIAN COUNTETIES THEY SRE 80 PERCENT CHORIODAL 12 PERCENT INVOLVE CILIARY BOFY 8 PERCENT AFFECT IRIS DIFFICULT TO DIAGNOSE DUE TO ATYPICAL PRESENTATATION HOWEVER IN MODT OF SITUATIONS PRESENT AS SOLID OR EXUDATIVE RETINAL DETACHMENT ON INDIRECT OPHTHALMOSCOPY OR B SCAN ULTRASOUND DIAGNOSTIC MODALITIES DIRECT OPHTHALMOSCOPY INDIRECT OPHTHALMOSCOPY A SACN ULTRASOUND B SCAN ULTRASOUND C T SCAN BRAINE M R I SCAN BRAIN INTRODUCTION IF THE TUMOUR IS ANT YO KENS PRESENTING FESTURES ARE BLUED VISION PARACENTRAL SCOTOMA PROGRESSGRADUALE AND PAINLESS VISUAL FIELD LOSS CASE REPORT AND RESULTS INN2011 A 55BYEARS OLD MALE PATIENT PRESENTED AS A CASE OF A C GLAUCOMA WITH MARKED CILIARY CONGESTION SHALLOW AC FIXED DILATED PUPIL IOP MORE THAN 40 MM HG RECEIVED ANTIGLAUCOMA MEDECATION IN THE FORM OF PROSTAGLANDINE ANALOGUES TIMILOL EYEBDROPS ONE DROP ONCE DORXOLAMIDE EYE DROPS ONE DROP 2VTIMES A DAY STERIOD EYE DROPS 4 TIMES A DAY Systemic I V 500 CC OF 20 MANNITOL 500MG IV ACETAZOLAMIDE EVEN WITH THIS REGEME OF TRESMENT EVEN AFTER 6 TO 8NHOURD OF TREAMENT PT DID NOT SHOW ANY SORT OF IMPROVEMENT HOWEVER NO B SCAN ULTRASOUND WAS DONE PT WAS ADVISED ADMISDION IN THE EYE HOSPITAL WHICH WAS REFUSED BY HIM LATER HE SECOND OPHTHALMIC OPION THIS TIME OPHTHALMOLOGIST PERFORMED B SCAN ULTRASOUND AND PICKED UP SOLID RETINAL DETACHMENT HE WAS REFERED TO RADIOLOGIST FIR CONFERMATION OF MELANOMA CHORIOD FROM RADIOLOGICAL POINT OF VIEW BUT TO THE BAD LUCK OF BOTH PATIENT AND OPHTGAOLOGIST RADIOLOGICAL REPORT BWAS SO MISLEADING EVEN DONE TWICE THAT PATIENT LEFT IN DISAPPOUNTMENT AND THE FOR A PERIOD OF NEARLY TWO YEARS WAS GOING TO MANY OPHTHALMOLIGISTS WITHIUT ANY PROPER TREAMENT AS A PAINFUL BLIND EYE I HAPPEN TO SEE THE PSTIENT IN 2013 I DID B SCAN ULTRASOUNDS THERIR WAS A SOLID RETINAL DETACHMENT REFERRED HIM.TO MY RADIOLOGIST WHO GAVE A LOVELY REPORT OF 1 CONFERMATION OF MELANOMA RADIOLOGICALLY PITUATRY POSSA PIT GLAND BASAL GANGLIA ALL NORMAL OPTIC NERVE CHIASMA TRACT AND OPTIC RADIATION ALL NORMAL THALAMI MIDBRAIN CEREBRALHEMISPHERS VENTRICLES ALL NORMAL ULTRASOUND LIVER NORMAL MODALITIES OF TREAMENT OF CHORIODAL MELANOMA IF TUMOUR IS LESS THAN 22 MM OBSERVATION IF MORE THAN 22 ENUCLEATION PLAQUE BRACHOTHERAPY BLOCK RESECTION RADIOTHERAPY CHEMOTHERAPY PARAS PLANA VITRECTOMY PAN RETINAL PHOTOCOAGULATION IN SOME VERY RSRE AND SEVERE CASES ONE MAY DO EXENTERSTION HOWEVER ON THE M R I SCAN BRAIN AND RADIOLOGICAL REOORT I DECIDED TO GO FIR BLOCK RESECTION PT WAS ADMITTED BY ME AND AFTER ALL INVESTIGATIONS AND PRE ANASTHETIC EXAMINATION BLOCK RESECTION PROCEDURE WAS FONE UNDER G A REMOVING ALL THE CONTENTS OF EYE BALL LEAVING BEHIND INTACT SCLERAL CAVITY OR ITAL ADENEXA EXTRAOCULAR MUSCLES I STICHED ANY AND POST BLIOSBOF SCKERA WITH 6BZERI VIVIRYL AFTER FEW DAYS I PUT AN INTRAORBITAL CONFERMER TO INCRESE THE INTRAORBITAL VOLUME FOR BETTER FITTING OF PROSTHESES AFTER 2 TO 3VWE A WELL FITTING AND WELL MATCHING PROSTHESIS WAS PUT BY ME THE REMOVED OCCULAR SOECEMEN SENT FOR HISTOPATHOLOHICAL EXAMINSTION DID NOT SHOW ANY EVIDENCE OF MALIGNANCY DISCUSSION MORE THAN 6 YEARS HAVE PASSSED PATIEN IS PAIN FREE HAS A NICELY MATCHING AND FITTING PROSTHESIST M R I SCAN NORMAL ULTRASOUND LIVER NORMAL CONCLUSION IF WE HAVE A PATIENT OF A C GLAUCOMA NOT RESPONDING TO ANTIGLAUCOMA MEDECATION IMMEDIATELY FO B SCAN ULTRASOUND YO PUCK UP SOLID RETINAL DETACHMENT WHAT WAS THE LACUNES INNTHISBPSTIENTB WAS IN THE INITISL STAGE NONB SCAN ULTRASOUND WAS DONE REFRENCES IN INSTITUTE OF OPHTHALMOLOGY MANCHESTER LONDON A OATIENT OF A C GLAUCOMA DID NOT RESPOND TO ANTIGLAUCOMA MEDECATION VISION IN THE NORMAL EYE WASC6 /18 M R I SCAN BRAIN REVEALED CHORIODAL MELANOMA SO ENUCLEATION WAS DONE SOMETIMES CHORIODAL MELANOMA CAN PRESENT AS SEVONDRY GLAUCOMA THOUGH RARE IN INSTITUTE NOF OPHTGALMOLOGY AND PATHOLIGY NUNIVERSIT OF CARDIO ONE PATIENT OF SECONDRY GLAUCOMA HAD IOP OF MORE THAN 40 MM HG FID NOT REDPIND TO ANTIGLAUCOMA MEDECATION M R I SCAN BRAIN REVEALED CHORIODAL MELANOMA SO ENUCLEATION WAS DONE ONE CASE OF MALIGNANT MANOMA OF CILIARY BODY PRESENTED WITH OCCULAR HYPERTENSION OR CHRONIC UVEITS SOMETIMES WE HAVE UVEAL MELANOMA PRESENTING AS VERTEX VARICES IT IS A BENIGN CONDITIONING@

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very informative post @Dr. Gowhar Ahmad sir

Thank you doctor
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Choroidal melanoma presenting as glaucoma no response to medicines Other finding solid retinal detachment MRI diagnosed choroidal melanoma Enucleation done as tumor was more than 22 mm Nicely tackled case Due to absence of strait forward presentation and lagisty of different ophthalmologist not able to reach for exact diagnose We must go through different investigative modalities so the patient May be helped without delay

Thank you doctor
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I AGREE WITH YOU DEAR DR S SINGH FOR YOUR NICE COMMENTS STAY ALLWAYS SAFE AND BLESSED WITH YOUR FAMILY

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