veal melanoma (UM) is the most common primary intraocular malignant neoplasm in adults, occurring in 7 per million per year in the United States. 1 Multiple chromosomal abnormalities such as monosomy 3 and several genetic mutations have been reported in association with this tumor. [2][3][4][5] UV light, environmental factors, trauma, and viruses 6-10 have been implicated as the underlying cause. Furthermore, uveal nevus, congenital ocular or oculodermal melanocytosis, and benign diffuse uveal melanocytic proliferation have been suggested as predisposing factors. [11][12][13][14] It remains uncertain whether there is an association between Schnabel cavernous degeneration (SCD) and UMs. Schnabel cavernous degeneration is a rare histopathologic en-tity that appears as rarefaction and spongiform degeneration of the optic nerve substance posterior to the lamina cribrosa. Associated with a loss of myelin and axons, it is characterized by the presence of hyaluronidase-sensitive acid mucopolysaccharides within the cavernous spaces. [15][16][17] In a case report by Albert and colleagues, 18 a bilateral SCD of undetermined origin was found in a 26-year-old man with bilateral metastatic UM and no history of glaucoma. Sudden and pronounced elevation of intraocular pressure, forcing the vitreous into the cavernous spaces, was historically the main proposed mechanism for SCD. [19][20][21][22][23][24][25] Subsequently, marked reduction of blood flow of the optic nerve head and resultant ischemia have been proposed as the most important factors in SCD. 20 In a large case IMPORTANCE Schnabel cavernous degeneration (SCD) has been observed in eyes with uveal melanoma (UM), but, to our knowledge, a definitive study establishing the association between SCD and UM has not been conducted.OBJECTIVE To explore an association between SCD and UM.
DESIGN, SETTING, AND PARTICIPANTSA historical cohort analysis was performed using histologic slides and related clinical records of cases from the Collaborative Ocular Melanoma Study and Eye Pathology Laboratory at the University of Wisconsin, including 1985 UM eyes, 517 eye bank eyes, and 155 enucleated glaucomatous eyes.
MAIN OUTCOMES AND MEASURESThe prevalence of SCD was calculated and compared between each group; subgroup analysis was also conducted of eyes with and without SCD for the prevalence of glaucoma.RESULTS Schnabel cavernous degeneration was seen in 17 (0.9%) UM eyes, 9 (1.7%) eye bank eyes, and 2 (1.3%) enucleated glaucomatous eyes. No difference was detected between the prevalence of SCD in UM eyes and eye bank eyes (odds ratio [OR], 0.49; 95% CI, 0.22-1.10) or enucleated glaucomatous eyes (OR, 0.66; 95% CI, 0.15-2.89). Subgroup analysis, performed on 421 UM eyes, provided sufficient clinical information to definitively establish the presence or absence of glaucoma. Of the 95 (22.6%) eyes with glaucoma, 11 (11.6%) revealed histopathologic evidence of SCD. Compared with enucleated end-stage glaucoma eyes, this represents a 10-fold increase in SCD in UM eyes with glaucoma (OR, 10.10...