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. 2022 May 9;86(6):e20230073.
doi: 10.5935/0004-2749.20230073. Online ahead of print.

Scleral communication between Glaucoma drainage device capsule and the suprachoroidal space simulating amelanotic choroidal melanoma

Diego Queiroz  1 , Gustavo Porto Lustosa  1 , Diego Mascato  1 , Melina Correia Morales  1   2 , Arthur Gustavo Fernandes  1   2 , Rodrigo Antonio Brant Fernandes  1   2
Affiliations

Scleral communication between Glaucoma drainage device capsule and the suprachoroidal space simulating amelanotic choroidal melanoma

Diego Queiroz et al. Arq Bras Oftalmol. .

Abstract
in English, Portuguese

This is a case report involving a 56-year-old male patient with a history of pars plana vitrectomy due to a rhegmatogenous retinal detachment in the right eye that resulted in the implantation of a drainage device after the patient developed secondary glaucoma. Two years after the device's implantation, the patient was referred to our care as his visual acuity had decreased to 20/200 (1.00 LogMAR). At the fundus evaluation, a choroidal amelanotic elevation was observed at the upper temporal equator, and a potential diagnosis was made of amelanotic choroidal melanoma. The ultrasound exam visualized the patient's implanted superotemporal justabulbar drainage device, which revealed a transscleral communication from the plate fibrocapsular's draining space to the suprachoroidal space (fistula). The ultrasound also revealed a focal pocket of choroidal detachment in the patient's superotemporal region, simulating an amelanotic choroidal melanoma. A new pars plana vitrectomy was performed to remove the internal limiting membrane without repercussions at the fistula site. The patient's recovery progressed well, and he regained a visual acuity of 20/70 (0.55 LogMAR). To the best of our knowledge, this is the first case report of this condition.

Relato de caso de paciente 56 anos, sexo masculino, com histórico de vitrectomia via pars plana por descolamento de retina em olho direito e posterior implante de dispositivo de drenagem por glaucoma secundário. Dois anos após o procedimento foi encaminhado ao serviço por baixa de acuidade visual (AV) de 20/200 (1.00 LogMAR). À fundoscopia, observou-se uma elevação amelanótica temporal no equador com hipótese diagnóstica de melanoma de coroide amelanótico. O exame de ultrassom mostrou implante de dispositivo de drenagem justabulbar temporal superior com comunicação transescleral para espaço subcoroidal (fístula), sugerindo bolsão focal de descolamento de coroide em equador temporal superior simulando melanoma de coroide amelanótico. O paciente foi abordado cirurgicamente devido membrana epirretiniana com nova vitrectomia via pars plana para peeling de membrana limitante interna, sem repercussões no local da fístula, evoluindo bem com acuidade visual de 20/70 (0.55 LogMAR). Ao nosso conhecimento, este é o primeiro caso relatado nessa condição.

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Conflict of interest statement

Disclosure of potential conflicts of interest: None of the authors have any potential conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Retinography of the right eye. Elevated amelanotic lesion in the upper temporal equator with laser marks surrounding the lesion (TRC-50DX, Topcon, Japan).
Figure 2
Figure 2
Ultrasonography showing residual emulsified silicon oil in the vitreous cavity, a focal pocket of choroidal detachment, and a GDD juxtaposed at the superotemporal equator (A, longitudinal B-scan). The choroidal detachment was 3.91 mm thick and 9.96 mm in circumferential diameter (B, transverse B-scan). In the transverse view, a transscleral communication (yellow arrow M1) was observed in the inferior aspect of the choroidal detachment, juxtaposed at the inferior aspect of the fibrocapsular space containing the plate (echodense line, yellow arrow M2) of the GDD (C) (Aviso, Quantel Medical, France). GDD, glaucoma drainage device.
Figure 3
Figure 3
Intraoperative view during the epiretinal membrane peeling showing a localized superotemporal choroidal detachment.
Figure 4
Figure 4
OCT (A) pre- and (B) postsurgical treatment (Cirrus HD OCT, Zeiss, Switzerland). OCT, optical coherence tomography.
See this image and copyright information in PMC

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