Page 32 - The Freckled Eye - Book

pigment epithelium commonly improves areas of drusen, atrophy, and

contained pigment epithelial detachments.

Areas of phagocytic action, where cellular rubbles from melanocytes are

absorbed, provide the pigment epithelium coverings of coloration change.

Macrophages in these naturally orange areas include lipofuscin and melanin.

These changes can bring about choroidal neovascularization on the tumor,

with subsequent hemorrhage, subretinal exudation, and fibrous plaque

development.

Development of choroidal melanomas can take place silently till it creates

enough visual loss through several mechanisms. The tumor’s distraction of

choroidal flow and resulting ischemia typically bring about degeneration of

retinal photoreceptors and more retinal neurons. The retina covering the

tumor can split up into larger schisis cavities and cystoid spaces. There might

be related cystoid macular edema.

Generally, the farther the tumor’s starting point is from the fovea and optic

nerve, the bigger the tumor can grow into before the patient perceives a visual

field weakness. Fluid exudation into the sub-retina space with resulting retinal

detachment may increase the field loss. This exudation can bring about

complete retinal detachment. Infrequently, choroidal melanomas can invade

into core posterior ciliary nerves, bringing about serious ocular pain.

TREATMENTS OF CHOROIDAL MELANOMA