NECROTIC MELANOCYTOMA OF THE OPTIC DISK WITH CENTRAL RETINAL VASCULAR OBSTRUCTION

Central retinal artery occlusion in optic disk melanocytoma

Optic disk melanocytoma (ODM) is a rare benign tumor of the optic disk. We report a rare occurrence of profound visual loss due to central retinal artery occlusion associated with ODM in a 78-year-old female with no significant medical history. The clinical findings were supplemented by ancillary investigations.

Central retinal artery occlusion secondary to optic disk melanocytoma

PURPOSE

To report a case of central retinal artery occlusion with cilioretinal artery sparing associated with an optic disk melanocytoma.

METHODS

Retrospective observational case report.

RESULTS

A 29-year-old healthy male adult presented with sudden profound visual loss in the right eye since the past 3 days. His medical history was unremarkable with no history of antecedent trauma. Best-corrected visual acuity was 6/36 in the right eye and 6/6 in the left eye. The left eye was essentially normal. Right afferent pupillary defect was noted. Biomicroscopic examination of right fundus revealed an elevated, deeply pigmented, brown-black mass lesion over the optic disk, suggestive of melanocytoma. Other fundus findings were suggestive of central retinal artery occlusion with cilioretinal artery sparing. Clinical findings were confirmed on fundus fluorescein angiography, optical coherence tomography, ultrasonography, and visual field testing. Severe visual loss can occur because of retinal vascular occlusion in eyes with optic disk melanocytoma.

CONCLUSION

Rapid visual loss and retinal vascular occlusion associated with optic disk melanocytoma may not necessarily be caused by its malignant transformation. It may be caused by tumor necrosis itself. Although rare, it is still important to follow-up such patients closely to look for signs suggestive of malignant transformation.

Cardiovascular and thrombophilic risk factors in patients with retinal artery occlusion

This article evaluates the prevalence of cardiovascular and thrombophilic risk factors in patients with retinal artery occlusion. Forty-one patients with a first episode of a retinal artery occlusion underwent complete ophthalmic examination, routine blood testing and specific laboratory tests for thrombophilia, such as fasting and postmethionine homocysteine, lipoprotein(a), plasminogen activator inhibitor-1, factor VIII, factor V Leiden, factor II G20210A polymorphism, lupus anticoagulant and anticardiolipin antibodies. The control population consisted of 100 healthy individuals comparable as regards age and sex. At univariate analysis, hypertension, smoking, dyslipidaemia (both high cholesterol and triglyceride levels), antiphospholipid antibodies, hyperhomocysteinaemia, elevated factor VIII and lipoprotein(a) levels were significantly associated with retinal artery occlusion; at multivariate analysis, adjusted for age, sex, traditional and thrombophilic risk factors, smoking, hypercholesterolaemia, elevated homocysteine and lipoprotein(a) levels confirmed their independent role as risk factors for retinal artery occlusion. In conclusion, the results of the present pilot study demonstrate that the prevalence of hypercholesterolaemia and smoking and the 'thrombophilic burden' are increased in patients with retinal artery occlusion. Our findings may have implications for the management of these patients, suggesting the need for an intensive and tailored secondary prevention and new therapeutic approaches.