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   Table of Contents      
LETTER TO THE EDITOR
Year : 2018  |  Volume : 66  |  Issue : 8  |  Page : 1231

Response to comment on: A rare case of unilateral diffuse uveal melanocytic proliferation


Department of Vitreoretina, M. M. Joshi Eye Hospital, Hubballi, Karnataka, India

Date of Web Publication23-Jul-2018

Correspondence Address:
Dr. Apoorva Ayachit
M. M. Joshi Eye Hospital, Gokul Road, Hosur, Hubballi - 580 021, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_814_18

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How to cite this article:
Ayachit G, Ayachit A, Joshi S, Sameera V V. Response to comment on: A rare case of unilateral diffuse uveal melanocytic proliferation. Indian J Ophthalmol 2018;66:1231

How to cite this URL:
Ayachit G, Ayachit A, Joshi S, Sameera V V. Response to comment on: A rare case of unilateral diffuse uveal melanocytic proliferation. Indian J Ophthalmol [serial online] 2018 [cited 2020 May 24];66:1231. Available from: http://www.ijo.in/text.asp?2018/66/8/1231/237352



Sir,

We thank Dogra et al. for their keen interest and astute reading of our article.[1]

Like we mentioned in our report, the breast lesion was excised completely. Hence, monitoring the reduction in size of the breast lesion was not an option. The patient awaits a follow-up positron emission tomography scan as advised by the treating oncologist.

Every treatment for diffuse uveal melanocytic proliferation (DUMP) has to include concurrent treatment for primary malignancy. Hence, it is difficult to attribute the resolution of fluid to any of the proposed treatments for DUMP alone; be it steroids, plasmapheresis, and periocular or intravitreal treatment.[2]

Our case was a diagnostic dilemma in the beginning because there were choroidal elevations and extensive subretinal fluid, and the presentation was unilateral. Choroidal metastasis was an important differential. This was the reason we considered administering intravitreal bevacizumab (IVB) in the first place. It was a serendipitous discovery that IVB showed a reduction in fluid in this case (later diagnosed as DUMP because of its typical imaging features described in detail in our original article) along with symptomatic relief. Periocular steroid has also been used by another study group for DUMP with partial success. They had to repeat the injection after 5 months.[3]

It is unclear why DUMP has serous retinal detachments. Theories such as blood–retinal barrier breakdown (because of toxic or immunological products) and relative hypoxia because of hypermetabolic retinal pigment epithelium have been proposed. We hypothesize that similar to periocular steroids, bevacizumab helps ameliorate subretinal fluid due to its anti-permeability effects.[4],[5] It will be interesting to see if more cases of DUMP get successfully treated with bevacizumab to confirm or refute our hypothesis.

Acknowledgments

The authors wish to thank Dr. Kiran Kulkarni MD (Radiodiagnosis) for help provided in the radiologic workup of this patient.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Dogra M, Singh SR, Singh R, Dogra MR. Comment on: A rare case of unilateral diffuse melanocytic proliferation. Indian J Ophthalmol 2018;66:1230.  Back to cited text no. 1
  [Full text]  
2.
Jansen JC, Van Calster J, Pulido JS, Miles SL, Vile RG, Van Bergen T, et al. Early diagnosis and successful treatment of paraneoplastic melanocytic proliferation. Br J Ophthalmol 2015;99:943-8.  Back to cited text no. 2
    
3.
Joseph A, Rahimy E, Sarraf D. Bilateral diffuse uveal melanocytic proliferation with multiple iris cysts. JAMA Ophthalmol 2014;132:756-60.  Back to cited text no. 3
    
4.
Chahud F, Young RH, Remulla JF, Khadem JJ, Dryja TP. Bilateral diffuse uveal melanocytic proliferation associated with extraocular cancers: Review of a process particularly associated with gynecologic cancers. Am J Surg Pathol 2001;25:212-8.  Back to cited text no. 4
    
5.
O'Neal KD, Butnor KJ, Perkinson KR, Proia AD. Bilateral diffuse uveal melanocytic proliferation associated with pancreatic carcinoma: A case report and literature review of this paraneoplastic syndrome. Surv Ophthalmol 2003;48:613-25.  Back to cited text no. 5
    




 

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