Ophthalmic hypertension associated with uveal melanoma. Causes of diagnostic errors

Abstract

PURPOSE. To reveal the features of the clinical course of uveal melanoma with elevated intraocular pressure (IOP).

METHODS. The study retrospectively analyses case histories of 84 patients who received radical (liquidation) surgical treatment (enucleation or exenteration) for stage T3–T4 uveal melanoma in the ophthalmology department of MONIKI from 2015 to 2020.

RESULTS. The patients admitted for liquidation therapy of uveal melanoma had a stage T3 tumor (80–95%) and stage T4 tumor (4–5%). In almost a third of patients (in 25 out of 84 patients), an increase in IOP from 30 to 50 mm Hg (in average 37.57 mm Hg) was detected during the initial ophthalmologist visit. Two patients underwent antiglaucoma surgery in medical institutions at the place of residence. The waiting time from the appearance of first complaints to admission for treatment at an ophthalmic-oncologist ranged from 1 month to 18 months (median 3.5 months). Due to the late detection of uveal melanoma, four patients were referred to an ophthalmic-oncologist only after cataract phacoemulsification. The diagnosis of uveal melanoma was confirmed by histological examination of the enucleated eye. It is worth noting that pigmented forms of melanoma were detected in all patients with elevated IOP.

CONCLUSION. The initial examination of a patient with elevated IOP should involve special attention to possible intraocular tumors. Particular attention should be paid to the local expansion of the epibulbar vessels, delimited darkening of the sclera during transillumination, unusual pigmentation of the iris and anterior chamber angle. A thorough examination of the paired eye is of great importance. It is advisable for all patients with newly diagnosed glaucoma to undergo an ultrasound examination of the eye, and if indicated — ultrasound biometry of the anterior segment of the eye.