Acute Angle Closure Precipitated by Hemorrhage and Necrosis of a Large Uveal Melanoma in the Setting of Systemic Immunomodulatory Therapy

Abstract

Management of nonmetastatic uveal melanoma has been well studied and a large body of work has been published by the Collaborative Ocular Melanoma Study (amongst many others). Management of uveal melanoma that is found to be metastatic upon initial diagnosis, however, is less well defined. We report an interesting case of acute angle closure caused by necrosis and hemorrhage into a large uveal melanoma occurring shortly after initiation of immunomodulatory therapy with ipilimumab and nivolumab for metastatic disease. The use of these immunomodulatory agents in the setting of metastatic uveal melanoma is not well studied, and our case illustrates the importance of interdisciplinary communication in order to best decide the timing of surgical and systemic medical management to optimize outcomes and minimize morbidity.

Ocular Melanoma Presenting as Masquerade Syndrome

“…Haemorrhage in the anterior chamber may be the initial clinical sign of uveal melanoma [ 2 , 3 ] . As highlighted in this case, an intraocular haemorrhage and endogenous endophthalmitis suggest a neoplastic pathology (uveal melanoma).…”