Pseudomelanoma and Dislocated Lens

AM is a 75-year-old woman who was scheduled for cataract surgery on a 4+ nuclear sclerotic lens. The ophthalmologist had difficulty visualizing the fundus and performed a B-scan examination. When the probe was placed on the posterior temporal sclera against the orbital rim and aimed towards the cornea, a dome-shaped mass was imaged (Fig. 335). The diagnosis of a probable ciliary body melanoma was made and the patient was referred to an oncologist to be evaluated for systemic metastases. The workup was negative for tumor and a discussion was instituted regarding treatment options, including enucleation. This greatly concerned the patient and she sought a second opinion.

CD is a 43-year-old man with a history of a serious infection in his left eye years ago that resulted in some decreased sight in that eye. His vision had decreased slowly since that time and was very poor at the time of presentation to an optometrist. Examination found vision in that eye of counting fingers at 1 m and 20/30 in the right eye. Slit-lamp examination showed scarring of the right corneal stroma with a poor view of the anterior chamber and lens.