97th DOG Annual Meeting 1999



M. Eckhardt, J. Faulborn, G. Langmann, K. Müllner and N. Ardjomand

Background: Melanomas of the ciliary body have often a bad prognosis since they are often late diagnosed. The circular infiltration of the iridocorneal angle by malignant cells lead to secundary glaucoma.

Material and methods: In two cases the diagnosis "atypical pigmentary glaucoma" was made due to an elevated intraocular pressure, pigmentaion of the iridocorneal angle, but without changes of the iris. Both patients underwent conservative treatment at the beginning und then trabeculectomy was performed because of medical failure. In both cases changes of the iris appeared and the diagnosis was then changed to "ciliary body melanoma". In a third case a patient had a vitreous hemorrhage, which could not be stopped by pars plana vitrectomy and endophotocoagulation. A tumor of the ciliary body (pseudotumor) with 1 mm diameter was diagnosed as the cause of bleeding and photocoagulation was performed.

Results: In one case with "atypical pigmentary glaucoma" the histology revealed the diagnosis ringmelanoma. In the second case a ruthenium 106 plaque was applied since the patient refused an enucleation. In the case with vitreous bleeding the eye was enucleated six months after vitrectomy because of pain and missing function. The histology revealed a 13 mm high melanoma of the ciliary body with vitreous bleeding.

Conclusion: Ringmelanoma or bleeding melanomas of the ciliary body are rare, but in doubtful cases of unilateral glaucoma with unknown ethiology of dense pigmentation of the iridocorneal angle or unknown reason for vitreous bleeding, the diagnosis melanoma of the ciliary body should be considered.

Department of Ophthalmology, Auenbruggerplatz 4, A - 8036 Graz