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Marco Pellegrini, Carol Shields, Brad Kligman, Carlos Bianciotto, Jerry Shields; Ciliary Body and Choroidal Pseudomelanoma from Hypermature Cataract in 20 Cases. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4246.
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To describe pseudomelanoma of the ciliary body and choroid in eyes with opaque media from oblique ultrasonographic imaging through hypermature cataract.
Retrospective chart review of 20 eyes.
All eyes had opaque media from hypermature cataract with no view of the fundus. All were referred with uveal melanoma, based on ultrasonographic imaging. The melanoma was located in the ciliary body (n=17) or choroid (n=3). The median patient age was 54 years (range 17-86 years). Most patients were Caucasian (n=13) or African American (n=4). There was a history of eye trauma (n=3) and ocular surgery (n=1). The brunescent cataract was in anatomic position (n=18) or subluxated (n=2). On B-scan ultrasonography, the mass was dome (n=10) or elliptical (n=10) shape, acoustically hollow center with dense rim (n=20), located in the ciliary body (n=17) or choroid (n=3). The mean thickness was 7.2 mm and mean base was 9.3 mm. All 20 cases were diagnosed with pseudomelanoma from hypermature cataract. Features that suggested cataract rather than melanoma included lack of contiguity with the uvea (n=20) on videoimaging using standard ultrasonography and ultrasound biomicroscopy, lack of transillumination defect, and lack of sentinel vessel. For those in the ciliary body, an additional feature was the ultrasonographic presence of pseudomelanoma in all 4 quadrants (n=17), representing oblique imaging of the lens equator. For those in the choroid, the pseudomelanoma shifted when imaged reclined compared to upright positions. Following cataract surgery, the lack of melanoma was confirmed in all 20 cases.
Hypermature cataract can preclude a fundus view, necessitating ultrasonography for imaging the posterior segment of the eye. Ultrasonographic confusion with ciliary body and choroidal melanoma can occur as the dome-shaped cataract can simulate a dome-shaped melanoma. Consultation with an ocular oncologist is advised.
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