TY - JOUR
T1 - Inadvertent evisceration of eyes containing uveal melanoma
AU - Eagle, Ralph C.
AU - Grossniklaus, Hans E.
AU - Syed, Nasreen
AU - Hogan, R. Nick
AU - Lloyd, William C.
AU - Folberg, Robert
PY - 2009/2
Y1 - 2009/2
N2 - Objectives: To report an important complication of ocular evisceration therapy for blind, painful eyes that has been unreported in the literature, and to stress the need for careful preoperative evaluation to exclude occult neoplasms prior to therapy. Design: Multicenter, retrospective, nonrandomized clini-copathological case series of patients found to have previously unsuspected uveal malignant melanoma during histopathological examination of blind, painful eyes treated by evisceration. Results: Histopathological examination of evisceration specimens disclosed previously unsuspected uveal melanoma in 7 patients who were treated for blind, painful eyes. Inflammation caused by necrosis of the tumor and other ocular tissues led to misdiagnosis as endophthalmitis, orbital cellulitis, or idiopathic orbital inflammation in several cases. Preoperative imaging was not performed in 3 cases and failed to detect tumors in the remaining 4 cases. Failure of necrotic tumors to enhance contributed to misdiagnosis. Conclusions: The presence of a malignant intraocular neoplasm should be excluded prior to evisceration of any blind eye or blind, painful eye, particularly with opaque media. Necrosis-related inflammation can confound the clinical diagnosis of occult lesions, as can failure of necrotic tumors to enhance on imaging studies.
AB - Objectives: To report an important complication of ocular evisceration therapy for blind, painful eyes that has been unreported in the literature, and to stress the need for careful preoperative evaluation to exclude occult neoplasms prior to therapy. Design: Multicenter, retrospective, nonrandomized clini-copathological case series of patients found to have previously unsuspected uveal malignant melanoma during histopathological examination of blind, painful eyes treated by evisceration. Results: Histopathological examination of evisceration specimens disclosed previously unsuspected uveal melanoma in 7 patients who were treated for blind, painful eyes. Inflammation caused by necrosis of the tumor and other ocular tissues led to misdiagnosis as endophthalmitis, orbital cellulitis, or idiopathic orbital inflammation in several cases. Preoperative imaging was not performed in 3 cases and failed to detect tumors in the remaining 4 cases. Failure of necrotic tumors to enhance contributed to misdiagnosis. Conclusions: The presence of a malignant intraocular neoplasm should be excluded prior to evisceration of any blind eye or blind, painful eye, particularly with opaque media. Necrosis-related inflammation can confound the clinical diagnosis of occult lesions, as can failure of necrotic tumors to enhance on imaging studies.
UR - http://www.scopus.com/inward/record.url?scp=60549095007&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=60549095007&partnerID=8YFLogxK
U2 - 10.1001/archophthalmol.2008.543
DO - 10.1001/archophthalmol.2008.543
M3 - Article
C2 - 19204229
AN - SCOPUS:60549095007
SN - 0003-9950
VL - 127
SP - 141
EP - 145
JO - Archives of Ophthalmology
JF - Archives of Ophthalmology
IS - 2
ER -