Preretinal neovascularisation associated with choroidal melanoma

Background-The rare occurrence of iris neovascularisation and choroidal (su bretinal) neovascularisation in patients with choroidal melanoma has been r eported. However, the occurrence of preretinal neovascularisation (NVE) fed from the retinal circulation in eyes with choroidal melanoma is far less f requently reported. Methods-Three case reports of choroidal melanoma with the very rare finding of overlying NVE. Results-The three patients had choroidal melanomas, localised serous retina l detachment, and NVE. Two cases showed definite retinal capillary non-perf usion, and one of these two cases demonstrated retinal telangiectasis. One patient's melanoma responded quickly to iodine-125 plaque radiotherapy; how ever, the retinal neovascularisation persisted and caused vitreous haemorrh age. Localised scatter photocoagulation was successful in causing the compl ete regression of the neovascularisation. The other two patients had their eyes enucleated (one with planned pre-enucleation external beam radiotherap y). Demonstration of preretinal vessels in one of the cases was possible in histological sections. Conclusion-Preretinal neovascularisation may occur as a complication of cho roidal melanoma. Possible aetiologies include the release of tumour angioge nic factors, inflammation, chronic retinal detachment with secondary retina l ischaemia, retinal vascular occlusion secondary to retinal vessel invasio n by the tumour, or following radiation therapy. Optimal management of the neovascularisation is not known at this time. Supplemental localised scatte r photocoagulation may be of benefit in some cases.