Bilateral choroidal melanoma – two cases description and literature review

Aim of the study:
The aim of the study is to present two patients treated for bilateral choroidal melanoma.

Material and methods:
Retrospective case series. In each patient, the diagnosis was established based on the ophthalmoscopic image and confirmed with ultrasound examination.

Results:
The first patient was referred in 2008 with a posteriorly located choroidal melanoma. The globe was enucleated and the pathology report revealed epithelioid cell melanoma. Then, unfortunately, the patient was lost to follow-up, he presented 13 years later with the visual loss in the fellow eye to 0.2. The ophthalmoscopy and ultrasound revealed collar-stud choroidal melanoma stage T3a. The patient was treated with Ruthenium-106 brachytherapy and two series of transpupillary thermotherapy (TTT). Two years postoperatively, the tumor has reduced in size and the final best corrected visual acuity (BCVA) of the left eye was 0.4. The second patient was diagnosed in our clinic with choroidal melanoma stage T3a in the right eye in 2018. He underwent stereotactic radiotherapy (50 Gy in 5 fractions) and two series of TTT and finally, we achieved the reduction of tumor size and resorption of the retinal detachment. Six years later, during a routine follow-up examination, the second choroidal melanoma was found in the fellow eye with no visual complaints, and the patient underwent Ruthenium-106 brachytherapy.

Conclusions:
Although the occurrence of primary bilateral choroidal melanoma is very rare, the fellow eye of the patient needs to be carefully monitored as well during the postoperative follow-up.