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B. E. Kligman, C. G. Bianciotto, C. L. Shields, J. A. Shields; Ciliary Body Pseudomelanoma in Eyes With Opaque Media From Hypermature Cataract. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5157.
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To describe the clinical and ultrasonographic findings in eyes with opaque media referred with ultrasound evidence of ciliary body melanoma that later proved, following our examination, to be oblique imaging through hypermature cataract.
Retrospective chart review of 12 cases.
All 12 patients were referred with the diagnosis of ciliary body melanoma in an eye with opaque media from unilateral cataract. The median patient age was 52 years. The presenting symptom was blurred vision (n=9), leukocoria (n=1), pain (n=1), and no symptoms (n=1). There was a history of eye trauma (n=3) and ocular surgery (n=1). The initial visual acuity was hand motions (n=8), light perception (n=3), and no light perception (n=1). There was no ophthalmoscopic view of the fundus in any case. B-scan ultrasonography disclosed a dome-shaped, acoustically hollow ciliary body mass (n=12) with mean thickness of 8.5 mm and mean base of 9.3 mm, suggestive of melanoma. The features indicating pseudomelanoma included the mirrored appearance in all 4 ciliary body quadrants, bright echodense apex and base, subtle basilar separation from the uvea, lack of transillumination shadow, lack of sentinel vessels, and lack of ultrasound biomicroscopic mass. Following cataract surgery, the lack of ciliary body mass was confirmed in all cases.
Hypermature cataract often completely precludes a view of the fundus and ultrasonographic imaging might suggest a ciliary body mass if the edge of the lens is imaged. Clinical familiarity with melanoma features can assist in distinguishing the benign cataract from the malignant melanoma.
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