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   Table of Contents      
COMMENTARY
Year : 2019  |  Volume : 67  |  Issue : 12  |  Page : 2085

Commentary: Vitrectomy as a treatment modality in vitreous seeding secondary to ciliary body melanocytoma


Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralya, Chennai, Tamil Nadu, India

Date of Web Publication22-Nov-2019

Correspondence Address:
Dr. Pukhraj Rishi
Shri Bhagwan Mahavir Vitreoretinal Services, SankaraNethralaya, 18 College Road, Chennai - 600006, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1119_19

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How to cite this article:
Rishi P. Commentary: Vitrectomy as a treatment modality in vitreous seeding secondary to ciliary body melanocytoma. Indian J Ophthalmol 2019;67:2085

How to cite this URL:
Rishi P. Commentary: Vitrectomy as a treatment modality in vitreous seeding secondary to ciliary body melanocytoma. Indian J Ophthalmol [serial online] 2019 [cited 2019 Dec 15];67:2085. Available from: http://www.ijo.in/text.asp?2019/67/12/2085/271349



The variation in the presentation of anterior uveal tumors throws up several possibilities related to their management. Diagnostic work-up with slit-lamp examination, gonioscopy, transillumination test, ultrasound biomicroscopy (UBM), fluorescein angiography, and magnetic resonance imaging (MRI) help to reach a provisional diagnosis. One needs to establish the cystic/solid and melanocytic/nonmelanocytic nature of the tumor, and a decision about FNAC[1]/incision/excision biopsy[2],[3],[4],[5] is arrived at depending on the tumor size, location, and surgeon's familiarity of the biopsy technique. Often, the benign/malignant nature of the tumor can be established with this approach using histopathological and immunohistochemistry testing and a treatment plan is put in place. While benign, nonprogressive tumors can be observed, intervention is required for malignant or progressively enlarging tumors. In literature with adult subjects, surgical excision is successful for globe salvage in 71--81% with final visual acuity of ≥20/40 achieved in 50--53%, but has its own share of complications.[2],[3],[4] Complete surgical excision of intraocular tumor with established pathological evaluation leads to favorable long-term outcomes.

Management options for tumors with an established diagnosis of CB melanocytoma include observation, plaque radiation,[6] surgical excision, or enucleation. In the current study,[7] the authors have done well to surgically remove the dense pigmented vitreous floaters and achieved gratifying visual outcome. However, this report throws up other pertinent questions that the literature is deficient about. How does one predict the risk of recurrences of necrosis and pigment release, besides the rare possibility of malignant transformation?[8]



 
  References Top

1.
El-Harazi SM, Kellaway J, Font RL. Melanocytoma of the ciliary body diagnosed by fine-needle aspiration biopsy. Diagn Cytopathol 2000;22:394-7.  Back to cited text no. 1
    
2.
Shields JA, Shields CL, Shah P, Sivalingam V. Partial lamellar sclerouvectomy for ciliary body and choroidal tumors. Ophthalmology 1991;98:971-83.  Back to cited text no. 2
    
3.
Char DH, Miller T, Crawford JB. Uveal tumour resection. Br J Ophthalmol 2001;85:1213-9.  Back to cited text no. 3
    
4.
Damato B. The role of eyewall resection in uveal melanoma management. Int Ophthalmol Clin 2006;46:81-93.  Back to cited text no. 4
    
5.
Rishi P, Dhami A, Biswas j. Biopsy techniques for intraocular tumors. Indian J Ophthalmol 2016;64:415-21.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Shanmugam MP, Saxena M, Ramanjulu R, Tekwani P. Brachytherapy, a viable option of globe salvage in treatment of large ciliary body melanocytoma. Indian J Ophthalmol 2014;62:966-8.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Shanmugam PM, Sofi IA, Sagar P, Konana VK, Ramanjulu R. Vitrectomy as a treatment modality in vitreous seeding secondary to ciliary body melanocytoma. Indian J Ophthalmol 2019;67:2083-5.  Back to cited text no. 7
  [Full text]  
8.
Li HK, Shields CL, Shields JA, Eagle RC Jr, Mason JO 3rd. Iridociliochoroidal melanoma arising from melanocytoma in a black teenager. JAAPOS 2010;14:178 80.  Back to cited text no. 8
    




 

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