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      Characteristics of Optic Disc Melanocytomas Presenting with Visual Dysfunction

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          Abstract

          Objective and Design:

          A retrospective review study was designed to describe five cases of optic disc melanocytomas with tumor-related visual impairment.

          Participants:

          Five patients with optic disc melanocytoma presented with visual complaints to a tertiary eye hospital in Saudi Arabia.

          Materials and Methods:

          Demographic and clinical data were analyzed, including the results of ocular examination, lesion laterality, best-corrected Snellen visual acuity, pupillary reflex, visual field testing, color fundus photography, fundus fluorescein angiography, and ophthalmic ultrasound.

          Results:

          Visual dysfunction secondary to optic disc melanocytoma was identified. Case 1 had macular star edema with mild tumor enlargement, Case 2 had optic atrophy, Case 3 had juxtapapillary choroidal neovascular membrane with macular involvement, Case 4 had optic disc swelling with an enlarged blind spot, and Case 5 had a large altitudinal visual field defect.

          Conclusion:

          Although melanocytomas of the optic disc tend to have a benign behavior with slow evolution and stable vision, they may adversely affect visual function through a variety of mechanisms.

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          Most cited references12

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          Melanocytoma of optic disc in 115 cases: the 2004 Samuel Johnson Memorial Lecture, part 1.

          To report clinical variations and the natural course of melanocytoma of the optic disc. A retrospective study was conducted on a consecutive series of patients with melanocytoma of the optic disc who were evaluated at the Ocular Oncology Service at Wills Eye Hospital. Demographic information and variations in appearance and size of the tumor and local ocular complications were noted. Frequency of tumor growth and malignant transformation was recorded. Clinical factors, including patient data and tumor features, were analyzed for their impact on visual acuity loss of 2 or more Snellen lines and the tumor growth, using Cox proportional hazards regression models. Kaplan-Meier survival estimates of probability of visual acuity loss of 2 or more Snellen lines and probability of tumor growth were performed as a function of time from the initial examination. Visual acuity loss of 2 or more Snellen lines, tumor growth, and malignant transformation of the tumor. There were 115 patients (116 eyes) with melanocytoma of the optic disc. The mean age at diagnosis was 50 years; 38% of patients were male and 62% of patients were female; 65% of patients were white, 29% of patients were African American, and 6% of patients were Asian, Hispanic, Indian, or Arabic. The lesion was unilateral in 99% of patients. Visual symptoms that seemed to be related to the melanocytoma were present in 24% of patients, and an afferent pupillary defect was noted in 9% of patients. Associated ocular abnormalities included ocular melanocytosis (8%), racial melanosis (7%), optic nerve hypoplasia (2%), and retinitis pigmentosa (1%). The melanocytoma was dark brown to black in 100% of patients. The mean tumor diameter was 2 mm and the mean thickness was 1 mm. Associated findings included a choroidal component (54%), retinal component (30%), optic disc edema (25%), retinal edema (16%), localized subretinal fluid (14%), retinal exudation (12%), retinal hemorrhage (5%), vitreous seeds (4%), and retinal vein obstruction (3%). Fluorescein and indocyanine green angiography typically showed persistent hypofluorescence of the lesion. Using Kaplan-Meier survival curves, related visual loss occurred in 18% of patients by 10 years, and minor tumor enlargement occurred in 11% of patients by 5 years and in 32% of patients by 10 years. Malignant transformation was documented in 2 patients (2%). Although melanocytoma of the optic disc generally is considered to be a benign, stationary lesion, it can produce several local complications, can cause visual loss, can grow slowly, and, rarely, can undergo malignant transformation into melanoma. Patients with optic disc melanocytoma should undergo periodic ocular examination.
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            MELANOCYTES, MELANOCYTIC NEVI, AND MELANOCYTOMAS.

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              Clinical and follow-up studies of melanocytomas of the optic disc.

              Forty patients with melanocytoma of the optic disc were evaluated to determine their clinical variations and behavior. Follow-up examination of 1 to 19 years was obtained in 27 patients. Of the 27 lesions, four (15%) showed a slight increase in size, and one tumor (4%) decreased in size. The remaining 22 tumors (81%) have not yet demonstrated ophthalmoscopic changes. In spite of occasional growth, the melanocytoma is a benign tumor that requires no treatment.
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                Author and article information

                Journal
                Middle East Afr J Ophthalmol
                MEAJO
                Middle East African Journal of Ophthalmology
                Medknow Publications (India )
                0974-9233
                0975-1599
                Jul-Sep 2010
                : 17
                : 3
                : 242-245
                Affiliations
                Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
                Author notes
                Corresponding Author: Saba Al-Rashaed, Vitreoretinal Division, King Khaled Eye Specialist Hospital, P.O. Box 7191, Riyadh 11462, Saudi Arabia. E-mail: srashaed@ 123456kkesh.med.sa
                Article
                MEAJO-17-242
                10.4103/0974-9233.65488
                2934715
                20844679
                04eddcaa-3be2-443b-843b-55c4a0bc4167
                © Middle East African Journal of Ophthalmology

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Original Article

                Ophthalmology & Optometry
                optic disc,melanocytoma,visual function
                Ophthalmology & Optometry
                optic disc, melanocytoma, visual function

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