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The incidence of uveal melanoma, in particular that of the ciliary body, is very low in black people, including West Indians. When symptomatic, it manifests as decreased or impaired visual acuity and seldom, if ever, pain. We report a case of ciliary body melanoma that is of scientific interest for two reasons: 1) a West Indian melanoderm patient being affected, 2) presentation as a recurrent uveitis with a transient increase of intraocular pressure, and without any decline in visual acuity. We recommend that in any case of uveitis, black patients included, a ciliary body tumor should always be excluded by pupillary dilation., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Introduction: Uveal melanoma is the most common adult primary intraoculary tumor. Bilateral tumor is very rare, but must not be underestimated because early diagnosis and care improve the survival and the visual prognosis., Observation: We report the case of a patient treated for a left parapapillary choroidal melanoma by disk of ruthenium ((106)Ru), and a follow-up every 3 months for an atypical choroidal large-sized controlateral nævus levelling the macular area. This right nævus changed in 2009 leading to suspicion of a growing melanoma. Because the visual acuity of the left eye was limited to 20/2000, we wanted to confirm this growth before beginning a treatment. But for 3 years the tumor has remained stable and asymptomatic, with a disease staging still negative. To this day, no curative treatment has been started on the right eye., Discussion: In spite of clinical (To Find Small Ocular Melanomas (TFSOM) for example) and paraclinical arguments, it is sometimes difficult to differentiate a large nævus from an early melanoma. Evolution of the tumor often allows to confirm the diagnosis. However, the sole growth of a nævus is not specific of a choroidal melanoma. When confronted with suspicion of a small choroidal melanoma, some authors recommend an immediate treatment for the tumor; others prefer to confirm without a doubt a tumoral growth. It is necessary to weigh out the iatrogenic risks of a conservative treatment on the visual acuity in a monophtalm patient on one side, and the vital risk for the patient on the other side, which seems to be limited in case of small-sized melanoma with a slow evolution., Conclusion: A bilateral choroidal melanoma is rare. Systematic and repeated examinations of both eyes are essential. Management of these complicated cases often leads to discussion., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Purpose: To report and analyze the circumstances of uveal melanoma detection., Methods: The records of 143 consecutive patients diagnosed in the Ophthalmology Department of Gustave Roussy Institute between September 1994 and September 2001 were analyzed. The study included 66 females and 77 males, aged from 21 to 91 years (mean, 62.75 years)., Results: The first symptom was decreased visual acuity in 37% of cases. In 34.9%, there was no functional sign and a systematic fundus exam provided the diagnosis. Of the 143 patients, 18.8% presented alteration of the visual field or scotoma, 9.9% complained of phosphenes, 9% complained of metamorphopsia, and 6.5% complained of floaters. In 5.5% of cases, there was documented tumor growth. In 2%, the presence of extrascleral exteriorization was the first sign. At the time of diagnosis, anterior tumors tended to be significantly larger than posterior tumors (p<0.007). Smaller lesions were significantly associated with a systematic detection of the tumor (p<0.005). Liver metastasis occurred more frequently with ciliary body melanomas (p<0.001), which were more frequently the largest lesions., Conclusion: These results emphasize the importance of early detection of uveal melanoma. We recommended frequent fundus examination after pupil dilatation.

Purpose: To evaluate the use of intravenous vitreous fluorophotometry in assessment of the blood-aqueous barrier in eyes with uveal melanoma., Method: Vitreous fluorophotometry was performed before treatment in 14 patients with uveal melanoma. Both eyes of patients were examined, and fifteen control healthy patients were examined between November 1996 and December 1996 at the department of ophthalmology of Bicêtre hospital., Results: Tumors with height > 6 mm and serous retinal detachments were accompanied by marked alterations of the blood-aqueous barrier, vitreous fluorophotometry showed diffusion of dye in posterior, mid and anterior vitreous: 2.99 ng/ml in the posterior vitreous and 5.20 ng/ml in the anterior vitreous. The posterior vitreous fluorescence at 60 minutes in the control eyes was 1.43 ng/ml and 1.30 ng/ml in the anterior vitreous. Diffusion of dye was present in the posterior vitreous in patients with tumor height less than 6 mm: 2.38 ng/ml (1.43 ng/ml in control eyes) at 60 minutes., Conclusions: Fluorophotometry provides a method for the assessment of the blood-aqueous ocular barrier in eyes with choroidal melanoma.