Yap E Y, Robertson D M, Buettner H
Department of Ophthalmology, Mayo Clinic, Rochester, MN 55905.
Ophthalmology. 1992 Nov;99(11):1693-7. doi: 10.1016/s0161-6420(92)31744-0.
The purpose of this article is to present the unusual circumstances in which malignant melanoma of the choroid can masquerade as scleritis, thus confounding its diagnosis.
Three cases of plaque-like malignant melanomas of the choroid are reported that, on initial examination, had features of scleritis. The events leading to their eventual correct diagnosis also are presented.
In each case, there was ocular pain, blurred vision, anterior chamber and/or vitreous cavity cellular reaction, and an exudative retinal detachment associated with an ill-defined, relatively flat variably pigmented choroidal mass. In all three cases, the inflammatory component responded promptly to corticosteroid treatment and was accompanied by visual improvement. In two eyes, shrinkage of the choroidal mass accompanied the corticosteroid treatment, lending support to a working diagnosis of scleritis. By demonstrating expansion of the choroidal masses, examination of sequential fundus photographs influenced the decision to enucleate the eyes for presumed malignant choroidal melanoma.
Clinicians should be alert to the circumstances in which malignant melanomas of the choroid can masquerade as scleritis. Careful evaluation by ophthalmoscopy, ultrasonography, fundus photography, and subsequent sequential examination is necessary to arrive at the correct diagnosis.
本文旨在介绍脉络膜恶性黑色素瘤可伪装成巩膜炎的特殊情况，从而混淆其诊断。
报告3例脉络膜斑块状恶性黑色素瘤病例，这些病例在初次检查时具有巩膜炎的特征。还介绍了最终正确诊断这些病例的过程。
在每例病例中，均存在眼痛、视力模糊、前房和/或玻璃体腔细胞反应，以及与边界不清、相对扁平且色素沉着不一的脉络膜肿物相关的渗出性视网膜脱离。在所有3例病例中，炎症成分对皮质类固醇治疗反应迅速，并伴有视力改善。在2只眼中，皮质类固醇治疗后脉络膜肿物缩小，支持巩膜炎的初步诊断。通过显示脉络膜肿物增大，对系列眼底照片的检查影响了因疑似脉络膜恶性黑色素瘤而摘除眼球的决定。
临床医生应警惕脉络膜恶性黑色素瘤可伪装成巩膜炎的情况。通过检眼镜检查、超声检查、眼底摄影及后续的系列检查进行仔细评估，对于做出正确诊断是必要的。
