[Diagnostic problems in intraocular melanoma]

To evaluate accuracy of the diagnosis, rate of advancement and therapeutic possibilities of intraocular malignant melanomas, basing on our one-year clinical material.

The total of 288 consecutive patients with suspicion or diagnosis of intraocular malignant melanoma, referred in the year 1997 to the Department of Ophthalmology CM UJ, were analysed. There were 121 males and 167 females, aged 22-76, mean 50. The period of time between the patient's first ocular symptoms and his visit to the ophthalmologist ranged between 7 days and several years. Besides routine ophthalmological examination each patient underwent USG and, if necessary AF, ICG, CT and IMR.

Diagnosis of malignant melanoma was confirmed in 141 cases. Among these patients in 69 brachytherapy was applied, in 20 surgical resection of the tumor and in 52 enucleation. In 111 cases other following diseases were diagnosed: iris cysts, deficient iridectomy, iris nevus, choroidal nevus, metastatic tumors, age-related macular degeneration, myelinated nerve fibres, Leber-Coats syndrome, toxoplasmosis and granulomatous uveitis. In 36 cases the diagnosis was not exact and those patients remained under periodic clinical observation.

Our study shows that in many patients intraocular malignant melanoma is diagnosed too late and in these cases enucleation is the only method of treatment. The most diagnostic challenges are connected with differentiation of choroidal melanoma from choroidal nevus and exudative form of age-related macular degeneration.