Bilateral Diffuse Uveal Melanocytic Proliferation

A patient with a past medical history of bladder and lung cancer s/p primary excisional therapy, chemotherapy, and a short course of immunotherapy presented with a recent episode of blurry vision in both eyes. Patient’s exam was notable for visual acuity of 20/30 in the right eye and 20/40 in the left eye. Intraocular pressure was 14 and 13 in the right and left eye, respectively. Slit lamp exam was notable for multiple iris freckles and posterior chamber intraocular lenses in both eyes. Fundus exam was notable for mottling of the RPE as well as presence of multiple large, hyperpigmented lesions in both eyes. Imaging was performed including fundus photos, OCT, fundus autofluorescence, fluorescein angiography and indocyanine green studies in both eyes. Imaging revealed large melanocytic lesions that corresponded to dense areas of hypocyanescence as well as patches of RPE that exhibited hyperautofluoresence and hyperfluorescence. Based on the clinical and imaging findings, a paraneoplastic syndrome was diagnosed. Plasmapheresis was not recommended given a plan from patient’s primary team to resume immunotherapy for her primary malignancy.

Presentation Date: 01/26/2023

Issue Date: 02/03/2023