Anna M Lentzsch1, Robert Siggel, Christel Spital, Udo Holtick, Sandra Liakopoulos. 1. Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany Department of Ophthalmology, Helios University Hospital Wuppertal, University of Witten-Herdecke, Germany Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Germany.
Abstract
PURPOSE: To report a case of bilateral diffuse uveal melanocytic proliferation (BDUMP) over 30 months follow-up. METHODS: Multimodal imaging including ultrawidefield color fundus photography, blue light fundus autofluorescence, swept-source optical coherence tomography, fluorescein and ICG angiography. RESULTS: A 49-year old female presented with decreased vision two months after bladder cancer surgery. Exudative retinal detachment as well as leopard spot pattern chorioretinopathy was observed in the right eye. Chemotherapy and cystectomy were initiated. Progressive bilateral vision loss occurred with melanocytic proliferation, choroidal thickening, subretinal fibrosis, fluid extravasation, rapid development of mature cataract, multiple iris cysts and rubeosis despite plasmapheresis and intravenous immunoglobulins (IVIG). Following cataract surgery, massive fibrin reaction resulted in a ciliolenticular block. One year later, positron emission tomography-computed tomography (PET-CT) revealed absence of metastases. At month 23, choroidal thickness increased in line with tumor progression. Palliative systemic therapy was initiated. Secondary macular neovascularization (MNV) was treated with intravitreal anti-vascular endothelial growth factor (VEGF) injections. Visual acuity was light perception in the right and 20/200 in the left eye at last follow-up. CONCLUSION: BDUMP results in progressive melanocyte proliferation and exudation, leading to severe visual loss. In our case, visual acuity was preserved at a low level in one eye under continuous systemic treatment. Systemic corticosteroids are recommended for cataract surgery in the setting of BDUMP to prevent massive fibrin reaction. Intravitreal anti-VEGF injections may be indicated if secondary MNV develops.
PURPOSE: To report a case of bilateral diffuse uveal melanocytic proliferation (BDUMP) over 30 months follow-up. METHODS: Multimodal imaging including ultrawidefield color fundus photography, blue light fundus autofluorescence, swept-source optical coherence tomography, fluorescein and ICG angiography. RESULTS: A 49-year old female presented with decreased vision two months after bladder cancer surgery. Exudative retinal detachment as well as leopard spot pattern chorioretinopathy was observed in the right eye. Chemotherapy and cystectomy were initiated. Progressive bilateral vision loss occurred with melanocytic proliferation, choroidal thickening, subretinal fibrosis, fluid extravasation, rapid development of mature cataract, multiple iris cysts and rubeosis despite plasmapheresis and intravenous immunoglobulins (IVIG). Following cataract surgery, massive fibrin reaction resulted in a ciliolenticular block. One year later, positron emission tomography-computed tomography (PET-CT) revealed absence of metastases. At month 23, choroidal thickness increased in line with tumor progression. Palliative systemic therapy was initiated. Secondary macular neovascularization (MNV) was treated with intravitreal anti-vascular endothelial growth factor (VEGF) injections. Visual acuity was light perception in the right and 20/200 in the left eye at last follow-up. CONCLUSION:BDUMP results in progressive melanocyte proliferation and exudation, leading to severe visual loss. In our case, visual acuity was preserved at a low level in one eye under continuous systemic treatment. Systemic corticosteroids are recommended for cataract surgery in the setting of BDUMP to prevent massive fibrin reaction. Intravitreal anti-VEGF injections may be indicated if secondary MNV develops.