Peripheral subretinal pigment accumulation following transpupillary thermotherapy for choroidal melanoma.

Transpupillary thermotherapy (TTT) used as either an adjunct to plaque brachytherapy or a primary treatment for choroidal melanoma can cause several intraocular complications, particularly in the retina. A 61-year-old woman had a macular choroidal melanoma measuring 8 x 7.5 X 3.6 mm and received TTT in three sessions, each 6 months apart. After the second treatment, pigmented material began to accumulate on the peripheral retina with an increasing pace. The tumor gradually regressed for 16 months, followed by a sudden regrowth. Enucleation of the eye revealed that the peripheral subretinal pigmented deposits consisted of pigment-laden macrophages and retinal pigment epithelial cells without viable tumor cells. The rare complication of peripheral subretinal pigment dispersion following TTT should not be alarming, but close monitoring is recommended.

Topical thrombin-related corneal calcification.

PURPOSE: To report a highly unusual case of corneal calcification after brief intraoperative use of topical thrombin. METHODS: A 44-year-old man underwent sclerouvectomy for ciliochoroidal leiomyoma, during which 35 UNIH/mL lyophilized bovine thrombin mixed with 9 mL of diluent containing 1500 mmol/mL calcium chloride was used. From the first postoperative day, corneal and anterior lenticular capsule calcifications developed, and corneal involvement slightly enlarged thereafter. RESULTS: A year later, 2 corneal punch biopsies confirmed calcification mainly in the Bowman layer. Topical treatment with 1.5% ethylenediaminetetraacetic acid significantly restored corneal clarity. Six months later, a standard extracapsular cataract extraction with intraocular lens placement improved visual acuity to 20/60. CONCLUSION: This case suggests that topical thrombin drops with elevated calcium concentrations may cause acute corneal calcification in Bowman layer and on the anterior lens capsule.