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Inadvertent evisceration of eyes containing uveal melanoma
Journal article   Open access   Peer reviewed

Inadvertent evisceration of eyes containing uveal melanoma

Ralph C Eagle Jr, Hans E Grossniklaus, Nasreen Syed, R Nick Hogan, William C Lloyd III and Robert Folberg
Archives of ophthalmology (1960), Vol.127(2), pp.141-145
02/2009
DOI: 10.1001/archophthalmol.2008.543
PMCID: PMC2989176
PMID: 19204229
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https://doi.org/10.1001/archophthalmol.2008.543View
Published (Version of record) Open Access

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Abstract

To report an important complication of ocular evisceration therapy for blind, painful eyes that has been unreported in the literature, and to stress the need for careful preoperative evaluation to exclude occult neoplasms prior to therapy. Multicenter, retrospective, nonrandomized clinicopathological case series of patients found to have previously unsuspected uveal malignant melanoma during histopathological examination of blind, painful eyes treated by evisceration. Histopathological examination of evisceration specimens disclosed previously unsuspected uveal melanoma in 7 patients who were treated for blind, painful eyes. Inflammation caused by necrosis of the tumor and other ocular tissues led to misdiagnosis as endophthalmitis, orbital cellulitis, or idiopathic orbital inflammation in several cases. Preoperative imaging was not performed in 3 cases and failed to detect tumors in the remaining 4 cases. Failure of necrotic tumors to enhance contributed to misdiagnosis. The presence of a malignant intraocular neoplasm should be excluded prior to evisceration of any blind eye or blind, painful eye, particularly with opaque media. Necrosis-related inflammation can confound the clinical diagnosis of occult lesions, as can failure of necrotic tumors to enhance on imaging studies.
 Orbital Pseudotumor - diagnosis Melanoma - diagnosis Pain - surgery Humans Middle Aged Male Tomography, X-Ray Computed Orbital Cellulitis - diagnosis Necrosis Diagnostic Errors Aged, 80 and over Pain - etiology Uveal Neoplasms - diagnosis Endophthalmitis - diagnosis Female Aged Blindness - surgery Retrospective Studies Blindness - etiology Orbit - pathology Eye Evisceration

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