Cystoid macular edema as the initial manifestation of choroidal melanoma
A 52-year-old healthy man presented with decreased vision in the left eye (OS) for more than two months. Visual acuity was 20/20 right eye (OD) and 20/60 OS. Fundus examination disclosed CME OS, confirmed with fluorescein angiography and optical coherence tomography (OCT) at 733 microns thickness. In addition, there was a choroidal melanoma, located at the superotemporal equator, with basal dimension of 13 mm. []. Extramacular overlying serous retinal detachment and chronic retinal pigment epithelial (RPE) atrophy was noted. There was retinal invasion over the tumor apex and a prominent draining retinal vein. The lesion displayed acoustic hollowness and measured 4 mm thickness on ultrasonography.\nThe melanoma was treated with plaque radiotherapy (8 000 cGy apical dose) combined with three sessions of transpupillary thermotherapy. Additional intravitreal bevacizumab was delivered to assist in resolution of CME. At ten months, there was an improvement in the visual acuity to 20/40 OS as a result of reduction in CME to 329 microns. At 30 months, stable tumor regression to 1.2 mm was documented, but visual acuity decreased to 20/100 from radiation maculopathy, with foveal thickness of 609 microns.