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PHOTO ESSAY
Year : 2021  |  Volume : 1  |  Issue : 1  |  Page : 69-70

Neuroretinitis: A rare presentation of optic disc melanocytoma


1 Department of Ophthalmology, Father Mullers Medical College, Mangalore, Karnataka, India
2 Jyothis Eye Care Center, Kannur, Kerala, India

Date of Submission07-Apr-2020
Date of Acceptance30-Jul-2020
Date of Web Publication31-Dec-2020

Correspondence Address:
Dr. B Sripathi Kamath
Department of Ophthalmology, Father Muller Medical College, Kankanady Mangalore - 575 002, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_867_20

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  Abstract 


Keywords: Optic disc melanocytoma, optic neuritis, Neuroretinitis


How to cite this article:
Kamath B S, Shenoy D, Velandy J, Mendonca N. Neuroretinitis: A rare presentation of optic disc melanocytoma. Indian J Ophthalmol Case Rep 2021;1:69-70

How to cite this URL:
Kamath B S, Shenoy D, Velandy J, Mendonca N. Neuroretinitis: A rare presentation of optic disc melanocytoma. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Mar 3];1:69-70. Available from: https://www.ijoreports.in/text.asp?2021/1/1/69/305543



A 25-year-old male presented with sudden onset painless diminution of vision in the right eye of 1-week duration. Best-corrected visual acuity in the right eye was 20/200N 12; the left eye was 20/20N6; Normal color vision in left eye. Anterior segment was normal in both eyes except for relative afferent pupillary defect in the right eye. Left eye fundus was normal [Figure 1]b. Fundus of the right eye showed a blackish pigmented lesion on the surface of the disc obscuring the details of the disc and the cup engulfing a small portion of the inferior retinal vein [Figure 1]a. Vessels were faintly seen through the lesion. The rest of the optic disc appeared edematous with blurred disc margins. Faint superficial flame-shaped hemorrhage noted along the inferior margin of the optic disc. Peripapillary edema with macular edema noted with the rest of the retinal background and peripheral retina appeared normal. Fundus Fluorescein angiography showed blocked fluorescence and superior disc leak [Figure 1]c. Diagnosis of optic disc melanocytoma with optic neuritis was made. The patient was treated with oral steroids (1 mg/kg body weight), tapered over the next 3 weeks. Vision improved significantly to 20/20 in the first week with the formation of a macular star and resolution of macular edema [Figure 1]d and [Figure 2]b. Differentials of ischemic optic neuropathy, central serous retinopathy, malignant transformation of optic disc melanocytoma, malignant melanoma should also be ruled out.
Figure 1: (a) Fundus photo of the right eye showing pigmented lesion on the disc with disc edema, peripapillary and macular edema. (b) Fundus photo of the left eye showing normal fundus. (c) Fundus fluorescein angiography of the right eye showing pigmented lesion blocking usual disc fluorescence and disc leak at the superior border and diffuse hyperfluorescence at the inferior macular area. (d) Fundus photo of the right eye showing resolving disc edema and formation of the macular star

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Figure 2: (a) Spectral domain Optical coherence tomography of the right eye showing serous macular detachment involving the macular and peripapillary area with the central subfoveal thickness of 670 microns. (b) Spectral domain Optical coherence tomography of the right eye showing resolution of macular edema with outer retinal hyperreflectivities (related to macular star)

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  Discussion Top


Optic disc melanocytoma is characteristically dark brown to black colored benign lesions usually located on the optic nerve head, largely asymptomatic discovered only on routine ophthalmic evaluation with small possibility of lesion turning malignant.[1],[2] Common complications associated are retinal vein obstruction, optic nerve infiltration, tumor enlargement or necrosis, visual field defects, and choroidal neovascular membranes.[2]

Ischemic necrosis of the melanocytoma in the postlaminar region, causing cytokine-mediated inflammation of the optic nerve and neuroretinitis is the possible hypothesis.[3],[4] Previous reports suggested delayed and incomplete visual recovery unlike in our case which showed dramatic and faster recovery probably due to steroid therapy.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Shields JA, Shields CL. Intraocular Tumors. Philadelphia: WB Saunders, 1992. p. 101-15.  Back to cited text no. 1
    
2.
Shields JA, Demirci H, Mashayekhi A, Eagle RC Jr, Shields CL. Melanocytoma of the optic disk: A review. Indian J Ophthalmol 2019;67:1949-58.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Garcia-Arumi J, Salvador F, Corcostegui B. Neuro retinitis associated with melanocytoma of the optic disc. Retina 1994;14:173-6.  Back to cited text no. 3
    
4.
Shanmugham MP, Khetan V, Sinha P. Optic disc melanocytoma with neuroretinitis. Retina 2004;24:317-8.  Back to cited text no. 4
    


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