Title

MACULAR EXUDATION IN OLD-AGE PATIENT WITH MELANOCITIC LESION ASSOCIATION: DIFFERENTIAL DIAGNOSIS

Introduction

The purpose of this report is to present a case of an unilateral hyperpigmented macular lesion associated with exudation in a old-age patient.

Methods

This is a case report of a patient examined at the Centro Oftalmológico de Minas Gerais on January 2020.

Results

A 73 year old man presented to exam complaining of long data low vision in the right eye (OD). Exam revealed best visual acuity of hand movement in OD and 20/150 in the left eye (OS). Fundoscopy revealed a large and elevated macular hyperpigmented lesion in OD, and macular drusen in both eyes (OU). The differential diagnosis of a choroidal melanoma (CM) must be performed. A previous fluorescein angiography (FA) revealed the estability of the lesion, without double circulation, and sugested choroidal neovascular membrane (CNVM) in both eyes. Optical coherence tomography revealed a CNVM with little fluid in OU and an elevated choroidal lesion in OD. An ocular ultrasound was perfomed and revealed a regular lesion measuring 7,97mm base and 1,71mm high.

Discussion

Age related macular degeneration (AMD) is the main cause of legal blindness in patients above 60 years old, a known risk fator.Neovascular AMD is characterized by a CNVM that causes fluid leakage leading to central vision loss, wich fits this case. The CM is the most common primary ocular tumor in the adult. The consequences of not being diagnosed are catastrophic. The FA is a good method to suggest the diagnosis, a double ciculation can be observed in the early fases, due to the choroidal vasculature origination. The main differential diagnosis is with choroidal nevus (CN), wich is usually assintomatic, with drusen and measures <1mm high and <5mm of base. Risk factors of malignant conversion are >2mm high and subretinian fluid. Although our patient didn't have double circulation, the size of the lesion is a worrying risk. Having said that, neovascular AMD in association with a CN was confirmed in OD. Further evaluations must be performed due to the risk of malignance conversion

Keywords

Macular Degeneration, Choroidal Neovascularization, Choroid Neoplasms

Area

CLINICAL CASE

Authors

NADIA CAROLINA LIMA LIMA, VINICIUS CARRIERO LIMA, SIMONE LOPES OLIVEIRA, KARINE OLIVEIRA ANDRADE