Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida.
Arq Bras Oftalmol. 2023 Apr 17;87(5):e20220215. doi: 10.5935/0004-2749.2022-0215. eCollection 2023.
To report the clinical findings, treatments, and outcomes in a series of patients with vitreous metastasis from cutaneous melanoma.
This single-center, retrospective, interventional case series included patients with biopsy-confirmed vitreous metastasis from cutaneous melanoma diagnosed between 1997 and 2020. Standard 23- or 25-gauge pars plana vitrectomy was performed for diagnostic sampling. Sclerotomies were treated with double or triple freeze-thaw cryotherapy. Perioperative intravitreal injections of melphalan (32 µg/0.075 mL) were administered, when indicated. Visual acuity, intraocular pressure, and systemic and ocular treatment responses were reported.
Five eyes of five patients with unilateral vitreous metastasis from cutaneous melanoma were identified. The median age at diagnosis was 84 (range, 37-88) years. The median follow-up after ophthalmic diagnosis was 28 (8.5-36) months; one patient did not have a follow-up. The initial visual acuity ranged from 20/30 to hand motions. Baseline clinical findings included pigmented or non-pigmented cellular infiltration of the vitreous (5/5), anterior segment (4/5), and retina (3/5). Four patients had secondary glaucoma. Systemic therapy included checkpoint inhibitor immunotherapy (n=3, all with partial/complete response), systemic chemotherapy (n=2), surgical resection (n=3), and radiation (n=2). The median time from primary diagnosis to vitreous metastasis was 2 (2-15) years. One patient had an active systemic disease at the time of vitreous metastasis. The final visual acuity ranged from 20/40 to no light perception. Ophthalmic treatment included vitrectomy in all five patients, intravitreal administration of melphalan in three, and intravitreal administration of methotrexate in one. One patient required enucleation, and histopathology revealed extensive invasion by melanoma cells.
Vitreous metastasis from cutaneous melanoma can present as a diffuse infiltration of pigmented or non-pigmented cells into the vitreous and may be misdiagnosed as uveitis. Diagnostic pars plana vitrectomy and periodic intravitreal chemotherapy may be indicated.
报告一系列由皮肤黑素瘤引起的玻璃体转移患者的临床发现、治疗方法和结果。
本单中心回顾性干预性病例系列研究纳入了 1997 年至 2020 年间经活检证实为皮肤黑素瘤伴玻璃体转移的患者。对所有患者均行 23 或 25G 标准经睫状体平坦部玻璃体切除术进行诊断性取样。对巩膜切开处行双或三冷冻-解冻冷冻疗法。若有必要，在围手术期向玻璃体内注射氨甲蝶呤（32µg/0.075mL）。报告视力、眼内压以及全身和眼部治疗反应。
共发现 5 例 5 只眼单侧皮肤黑素瘤伴玻璃体转移。诊断时的中位年龄为 84 岁（范围，37-88 岁）。眼科诊断后中位随访时间为 28（8.5-36）个月；1 例患者无随访。初始视力从 20/30 到手动。基线临床发现包括 5/5 只眼玻璃体内有色素或无色素细胞浸润、4/5 只眼前段和 3/5 只眼视网膜受累。4 例患者有继发性青光眼。全身治疗包括检查点抑制剂免疫治疗（n=3，均有部分/完全缓解）、全身化疗（n=2）、手术切除（n=3）和放疗（n=2）。从原发诊断到玻璃体转移的中位时间为 2（2-15）年。1 例患者在玻璃体转移时仍有活动性全身疾病。最终视力从 20/40 到无光感。眼部治疗包括 5 例患者均行玻璃体切除术、3 例患者行玻璃体内氨甲蝶呤注射、1 例患者行玻璃体内甲氨蝶呤注射。1 例患者需要眼球摘除，组织病理学显示黑色素瘤细胞广泛浸润。
皮肤黑素瘤的玻璃体转移可表现为色素或无色素细胞弥漫性浸润玻璃体内，可能被误诊为葡萄膜炎。诊断性睫状体平坦部玻璃体切除术和定期玻璃体内化疗可能是必要的。
