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HOW TO CITE THIS ARTICLE: Mallappa S, Agrawal S. A case of plexiform neurofibroma with ocular manifestation J. Evid.

ABSTRACT:Presenting here the outcome of cataract surgery in a 40yr old male patient diagnosed with mature cataract with ocular hypotony. Patient was investigated and all the possible causes of hypotony were ruled out. This was followed by an uneventful cataract surgery with a good visual outcome and normal IOP.

A 48-year-old female presented to our institute with complaints of diminution of vision in right eye since 3 months. No other ocular complaints. Past history and family history was not significant.Ocular examination revealed visual acuity of 6/60 in right eye and 6/18 in left eye. Anterior segment was normal in both eyes. On dilated fundus evaluation, distant direct ophthalmoscopy showed a mass projecting behind the lens in inferotemporal quadrant from 6 to 9 o'clock position (Figure 1). Indirect ophthalmoscopy revealed a large elevated pigmented lesion approximately 8 DD in size present at posterior pole from 5-8 o'clock hours, approximately 1 DD below the disc with vascularisation seen over the mass (Figure 2). It was associated with retinal detachment from 4-8 o'clock position in inferior quadrant, macula was spared.Clinical observation was correlated on B-scan showing 11 x 11 mm pedunculated mushroom like choroidal mass in inferior quadrant with RD. The lesion had regular round margin with initial prominant spikes followed by internal spikes of moderate-to-low reflectivity (Figure 3). Extrascleral or optic nerve involvement not seen. OCT showed serous RD with normal retinal thickness (Figure 4).With clinical diagnosis of choroidal melanoma, patient was advised for routine blood investigation (including LFT), chest x-ray, CT abdomen, MRI brain and orbit to rule out any metastatic changes. She was referred to higher centre for oncologist and oculoplasty opinion on further management.