Kavanagh Marsha C, Everman Kelly R, Opremcak E Mitchell, Foster Jill A
Ophthalmic Surgeons and Consultants of Ohio, Columbus, Ohio, USA.
Ophthalmic Plast Reconstr Surg. 2008 Jul-Aug;24(4):334-6. doi: 10.1097/IOP.0b013e31817e91ce.
A 74-year-old man underwent cataract extraction and 4 months later developed a macula-off retinal detachment. The retinal detachment was repaired via pars plana vitrectomy. Postoperatively, hyphema and dense vitreous hemorrhage developed. The hyphema recurred after anterior chamber washout. The hemorrhage was evacuated via a second pars plana vitrectomy, during which profuse, uncontrollable hemorrhage from the vitreous cavity prevented intraocular visualization; the sclerotomy sites were closed without identification of the bleeding source. One month later, the patient presented with complete loss of vision and pain on the affected side. Examination revealed extensive rubeosis and conjunctival injection, a vascularized mass filling the retrolental space, and subconjunctival nodules at the sclerotomy sites. Enucleation was performed, and a mass was note to involve 95% of the posterior chamber without gross optic nerve invasion. Histopathologic examination confirmed malignant melanoma. The rapid, massive extrascleral extension of uveal melanoma through surgical sclerotomy sites demonstrated in this case has not been previously described.
一名74岁男性接受了白内障摘除术，4个月后发生黄斑脱离视网膜脱离。通过玻璃体切除术修复视网膜脱离。术后发生前房积血和严重玻璃体出血。前房冲洗后前房积血复发。通过第二次玻璃体切除术清除出血，术中玻璃体腔大量无法控制的出血妨碍了眼内观察；巩膜切开部位在未确定出血源的情况下关闭。1个月后，患者患侧视力完全丧失且疼痛。检查发现广泛虹膜新生血管和结膜充血，一个血管化肿块充满晶状体后间隙，巩膜切开部位有结膜下结节。进行了眼球摘除术，发现一个肿块累及95%的后房，未发现视神经明显受侵。组织病理学检查证实为恶性黑色素瘤。本例中葡萄膜黑色素瘤通过手术巩膜切开部位迅速、大量的巩膜外扩展此前未见报道。
