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INTRODUCTION: Choroidal melanoma is one of the subtypes of uveal melanoma and a relatively rare ophthalmic malignancy worldwide. However, it is scarce in Asian countries like Malaysia. PURPOSE: We present eight cases of patients with choroidal melanoma referred to Hospital Serdang, a tertiary centre for oculoplastic issues, from 2021 to 2022. METHOD: A retrospective case series of patients diagnosed with choroidal melanoma and referred to the Oculoplastic Clinic, Department of Ophthalmology, Hospital Serdang, was undertaken. RESULTS: A total of eight cases of choroidal melanoma were identified, with a median age of 65 years. Six of them were female, and two were male. There were five of Malay ethnicity, and three were Chinese. Progressive reduced vision (n = 6), noticeable ocular mass (n = 3), and visual field defect (n = 2) were the most common presenting symptoms. The mean tumour thickness was 21.25 mm (range = 10-56 mm), and the largest basal diameter ranged from 10 mm to 53 mm (mean = 22.5 mm). Most were large tumours (n = 7) and above the T3a stage. The level of lactate dehydrogenase (LDH) was elevated in three cases. Histopathologically, five of the tumours were epithelioid, while the other three were mixed types. All patients underwent enucleation (n = 5) and exenteration (n = 3) with one recurrence. One patient had liver metastasis on the diagnosis of choroidal melanoma. CONCLUSION: In Malaysia, there is an increasing number of cases of choroidal melanoma. Clinical evaluation remained the mainstay of diagnosis. Treatment should be based on multifactorial prognostication in addition to tumour size. The LDH level may be necessary for providing inexpensive but valuable prognostication and monitoring markers.
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@#Endogenous endophthalmitis accounts for approximately 5 – 10% of all endophthalmitis cases. We report a case of a middle-aged gentleman with underlying uncontrolled diabetes mellitus who presented with fever and generalised body weakness for one week. He was diagnosed with invasive Klebsiella syndrome based on blood culture with presence of bilateral pleural effusion, liver abscess, renal impairment and sphenoidal sinusitis. The patient developed sudden bilateral painless reduced vision on day two of admission. Ocular examination revealed bilateral severe anterior chamber reaction and severe vitritis that obscured the view of the fundus. Ocular B-scan ultrasonography showed multiple loculations in the posterior segment in both eyes. There was soft tissue density with calcification in the left sphenoid sinus on computed tomography of the orbit. He was treated for bilateral endogenous endophthalmitis with multiple intravitreal antibiotic injections, but showed no improvement. Functional endoscopic sinus surgery was performed and revealed that the left sphenoid sinus was filled with fungal balls. Following drainage of sphenoidal pus, there was resolution of vitritis and fundus examination showed features of underlying fungal infection with a “string of pearls” present along the vascular arcade of both eyes. The patient was diagnosed with bilateral endogenous endophthalmitis secondary to invasive Klebsiella syndrome with coexisting fungal endophthalmitis secondary to sphenoid mycetoma. In addition to repeated intravitreal antibiotic injections, he was also treated with systemic and topical antifungal therapy. At three months post treatment, the infection resolved and his vision improved from counting fingers to 6/36 bilaterally.
