Scientific correspondence
Preretinal neovascularisation associated with choroidal melanoma
Jennifer Leea, Sanjay Logania, Hesham Lakoshab, Robert P Schroedera, Rand Simpsonb, Lee M Jampola
a Department of
Ophthalmology, Northwestern University Medical School, Chicago, IL, USA, b The Princess Margaret Hospital, Toronto, Canada
Correspondence to: Lee M Jampol, MD, Department of Ophthalmology, Northwestern University Medical School, 645 N Michigan Avenue Suite 440, Chicago, IL 60611, USA
Accepted for publication 2 April 2001
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.
METHODSThree case
reports of choroidal melanoma with the very rare finding of overlying NVE.
RESULTSThe 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.
CONCLUSIONPreretinal
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.
© 2001 by British Journal of Ophthalmology
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