Table 2:
Clinical characteristics of eyes, their ophthalmic disease and their outcome
| eye 1 | eye 2 | eyes 3 + 4 | eye 5 | eye 6 | eyes 7 + 8 | eye 9 | eye 10 | eye 11 | eyes 12 + 13 | eyes 14 | |
|---|---|---|---|---|---|---|---|---|---|---|---|
| ophthalmic symptoms | blurry vision | blurry vision | blurry vision | floaters | blurry vision | floaters | floaters | blurry vision | asymptomatic | floaters | floaters |
| time to ocular symptoms (mos)^ | 16 | 13 | 4.5 | 5 | 5 | 86 | 22 | 19 | asymptomatic | 38 | 42 |
| time to ocular diagnosis (mos)* | 17 | 13 | 6 | 6 | 6 | 92 | 23 | 21 | 12 | 38 | 46 |
| laterality of disease | left eye | left eye | both eyes | right eye | left eye | both eyes | left eye | right eye | right eye | both eyes | right |
| initial vision | OS: 20/30 | OS: CF | OD: 20/400, OS: 20/100 | OD: 20/50 | OS: 20/63 | OD: 20/20, OS: 20/20 | OS: 20/30 | OD: 20/40 | OD: 20/20 | OD: 20/25, OS: 20/30 | OD: CF |
| clinical findings | amelanotic vitreous and AC cells | amelanotic vitreous cells, yellow retrolental debris | large yellow-white vitreous snowballs, fine amelanotic cells in AC, retinal infiltration | Amelanotic vitreous clumps | pigmented choroidal lesions, vitreous seeds, pigmented hypopon | Pigmented vitreous debris | amelanotic retrolental membrane, vitreous hemorrhage; amelanotic retinal infiltrate | vitreous hemorrhage, amelanotic retinal infiltration | pigmented vitreous debris, retinal infiltration OD | Vitreous pigment | Pigment in AC and vitreous |
| retinal detachment? | yes | yes | no | yes | yes | no | no | no | no | no | no |
| neovascularization? | iris (NVG), hyphema, vit heme prior to tx | iris (NVG) | no | no | no | no | no | iris (NVG) | no | no | no |
| elevated IOP? | yes (NVG) | yes (NVG) | no | no | yes | no | no | yes (NVG) | no | no | no |
| ophthalmic treatment | intravit bevazicumab, EBR(40Gy/ 20 fractions) | intravit. Melphalan (10μg), bevacizumab | EBROU (30Gy/10 fractions) | observation | EBR(37.5Gy/ 18 fractions), PPV, intravit melphalan (10μg × l, μg × 2), intracameral melphalan (5μg) | OD: PPVx2, Cryotherapy, endolaser, intravit melphalan 20mcg q1m x4 OS: PPV x2, endolaser | PPVxl, endolaser, EBR (40Gy/ 16 fractions), intravit melphalan 20mcg q1m x5 | EBR (40Gy/25 fractions), intravit bevacizumab x2 | observation | OS: PPV | enucleation |
| subsequent systemic treatment | dabrafenib, trametinib, encorafenib, binimetinib | nivolumab, urelumab, ipilimumab, PDL1-I, LAG3 inhibitor | nivolumab | ipilimumab, nivolumab | dabrafenib, trametinib, pembrolizumab | pembrolizumab | nivolumab | pembrolizumab | ipilimumab | ipilimumab, nivolumab | none |
| final vision^^ | NLP | LP | 20/30, 20/70 | HM | 20/70 | OD: LP; OS: 20/630 | 20/40 | 20/300 | OD HM | OD: 20/30; OS: 20/25 | enuc |
| Final ophthalmic disease status | Controlled | Responding | Controlled OU | Controlled | Controlled | Active disease OU | Controlled | Controlled | Controlled | OD: Untreated; OS: Controlled | enucfor BPE |
^
= time from initial diagnosis of metstatic cutaneous melanoma to first ocular symptoms
*
= time from initial diagnosis of metastatic cutaneous melanoma to ocular diagnosis,
^^
+ final visual at last follow up, mos = months, CF = count fingers, OD = oculus dextrus, OS = oculus sinister, OU = oculus uterque, AC = anterior chamber, IOP = intraocular pressure, intravit = intravitreous, tx = treatment, NVG = neovascular glaucoma, PPV = pars plana vitrectomy; EL = endolaser; EBR = external beam radiotherapy; IVM = intravitreal injection of melphalan; CPC = cyclophotocoagulation; LP = light perception; enuc = enucleation; BPE = blind painful eye