Abstract
BACKGROUND—The rare occurrence of iris neovascularisation and choroidal (subretinal) neovascularisation in patients with choroidal melanoma has been reported. However, the occurrence of preretinal neovascularisation (NVE) fed from the retinal circulation in eyes with choroidal melanoma is far less frequently reported. METHODS—Three case reports of choroidal melanoma with the very rare finding of overlying NVE. RESULTS—The three patients had choroidal melanomas, localised serous retinal detachment, and NVE. Two cases showed definite retinal capillary non-perfusion, and one of these two cases demonstrated retinal telangiectasis. One patient's melanoma responded quickly to iodine-125 plaque radiotherapy; however, the retinal neovascularisation persisted and caused vitreous haemorrhage. Localised scatter photocoagulation was successful in causing the complete regression of the neovascularisation. The other two patients had their eyes enucleated (one with planned pre-enucleation external beam radiotherapy). Demonstration of preretinal vessels in one of the cases was possible in histological sections. CONCLUSION—Preretinal neovascularisation may occur as a complication of choroidal melanoma. Possible aetiologies include the release of tumour angiogenic factors, inflammation, chronic retinal detachment with secondary retinal ischaemia, retinal vascular occlusion secondary to retinal vessel invasion by the tumour, or following radiation therapy. Optimal management of the neovascularisation is not known at this time. Supplemental localised scatter photocoagulation may be of benefit in some cases.
Full Text
The Full Text of this article is available as a PDF (146.5 KB).
Figure 1 .
Case 1. A medium sized, amelanotic, choroidal melanoma is seen with overlying serous retinal detachment that extends to the fovea. There are retinal pigment epithelial changes overlying the tumour. There is beading of overlying retinal veins and small fronds of retinal neovascularisation just inferior to the tumour.
Figure 2 .
Case 1. Fluorescein angiogram reveals abnormal retinal vasculature in the area of the tumour with dilatation and telangiectasia. Inferior to the tumour, the retinal vasculature ends abruptly and there are fronds of retinal neovascularisation. There is non-perfusion peripheral to the neovascularisation.
Figure 3 .
Case 1. Following brachytherapy and scatter photocoagulation, the tumour and neovascularisation have regressed.
Figure 4 .
Case 2. Colour fundus photograph demonstrates elevated choroidal mass with haemorrhage and fine preretinal vessels visible (arrow).
Figure 5 .
(A) Case 2. Fluorescein angiogram demonstrates fronds of preretinal vessels. (B) Case 2. Late phase of the angiogram shows leakage from the new vessels.
Figure 6 .
Case 2. Photomicrograph clearly shows preretinal neovascularisation. The underlying retina is degenerated and disorganised. The retina is detached from the underlying tumour. (Haematoxylin and eosin, original magnification ×40).
Figure 7 .
Case 3. A large, amelanotic, choroidal melanoma is seen with surrounding serous retinal detachment that extended into the macula. Retinal neovascularisation was present at the inferonasal edge of the tumour (arrows).
Figure 8 .
Case 3. Fluorescein angiogram reveals leakage of neovascular fronds. The angiogram suggests adjacent non-perfusion.
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Cavallo T., Sade R., Folkman J., Cotran R. S. Tumor angiogenesis. Rapid induction of endothelial mitoses demonstrated by autoradiography. J Cell Biol. 1972 Aug;54(2):408–420. doi: 10.1083/jcb.54.2.408. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Finkelstein D., Brem S., Patz A., Folkman J., Miller S., Ho-Chen C. Experimental retinal neovascularization induced by intravitreal tumors. Am J Ophthalmol. 1977 May;83(5):660–664. doi: 10.1016/0002-9394(77)90132-5. [DOI] [PubMed] [Google Scholar]
- Folkman J., Merler E., Abernathy C., Williams G. Isolation of a tumor factor responsible for angiogenesis. J Exp Med. 1971 Feb 1;133(2):275–288. doi: 10.1084/jem.133.2.275. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gartner S., Henkind P. Neovascularization of the iris (rubeosis iridis). Surv Ophthalmol. 1978 Mar-Apr;22(5):291–312. doi: 10.1016/0039-6257(78)90175-3. [DOI] [PubMed] [Google Scholar]
- Jampol L. M., Ebroon D. A., Goldbaum M. H. Peripheral proliferative retinopathies: an update on angiogenesis, etiologies and management. Surv Ophthalmol. 1994 May-Jun;38(6):519–540. doi: 10.1016/0039-6257(94)90146-5. [DOI] [PubMed] [Google Scholar]
- Johnson R. N., Irvine A. R., Char D. H. Inferences from beading of a retinal vein draining a choroidal melanoma. Br J Ophthalmol. 1986 Oct;70(10):764–765. doi: 10.1136/bjo.70.10.764. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lubin J. R., Gragoudas E. S., Albert D. M. Choroidal neovascularization associated with malignant melanoma: a case report. Acta Ophthalmol (Copenh) 1982 Jun;60(3):412–418. doi: 10.1111/j.1755-3768.1982.tb03032.x. [DOI] [PubMed] [Google Scholar]
- Vine A. K. Choroidal melanoma with disc and retinal neovascularization. Retina. 1983;3(2):118–120. doi: 10.1097/00006982-198300320-00009. [DOI] [PubMed] [Google Scholar]