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Titre

Late onset of choroidal melanoma as vitreoretinal dissemination

But	Although local retinal invasion by choroidal melanoma is well known in tumors presenting initially with Bruch’s membrane rupture, malignant melanocytic proliferation within the vitreous and noncontiguous retina is rarely documented. We report active melanoma cells with extensive retinal and vitreous invasion in an eye containing a choroidal melanoma managed two years prior by Iodine 125 plaque.
Méthodes	Retrospective description of the case with review of the literature.
Résultats	A 77-year old female with clinical diagnosis of choroidal melanoma staged T2a and presenting with a break through Bruch’s membrane was treated with 125 Iodine plaque in January 2016. Follow-up examinations showed a nice tumor response with decrease in tumor diameter and thickness. In August 2018, the patient developed neovascular glaucoma and vitreous hemorrhage. She underwent a phaco-vitrectomy during which multiple white-yellow round lesions disseminated over the retinal surface were documented. Marginal tumor recurrence was excluded by indirect ophthalmoscopy and ultrasonography. In front of a blind, painful eye, suspicious pseudohypopyon and vitritis, secondary enucleation was performed. The anatomopathological examination confirmed the non recurrent irradiated choroidal melanoma and the nonadjacent retinal and vitreous malignant melanocytic proliferation.
Conclusion	To our knowledge, this is the first case of late vitreoretinal spread of choroidal melanoma, initially treated with brachytherapy, with no evidence of contiguous recurrence. The atypical infiltration pattern suggests a role of the vitreous and/or internal limiting membrane as spreading vector, secondary to release of malignant cells into the vitreous through the break in Bruch’s membrane.
Conflit d'intérêt	Non

Auteur 1

Nom	OLDERS
Initiales	G
Institut	Ocular Oncology Unit, Institut Roi Albert II - Cliniques Universitaires St Luc (CUSL)
Ville	Brussels

Auteur 2

Nom	BARTOSZEK
Initiales	P
Institut	Ocular Oncology Unit, CUSL
Ville	Brussels

Auteur 3

Nom	DE POTTER
Initiales	P
Institut	Ocular Oncology Unit, CUSL
Ville	Brussels