Uveal melanoma with massive extrascleral extension via pars plana vitrectomy sites

A 74-year-old man underwent cataract extraction and 4 months later developed a macula-off retinal detachment. The retinal detachment was repaired via pars plana vitrectomy. Postoperatively, hyphema and dense vitreous hemorrhage developed. The hyphema recurred after anterior chamber washout. The hemorrhage was evacuated via a second pars plana vitrectomy, during which profuse, uncontrollable hemorrhage from the vitreous cavity prevented intraocular visualization; the sclerotomy sites were closed without identification of the bleeding source. One month later, the patient presented with complete loss of vision and pain on the affected side. Examination revealed extensive rubeosis and conjunctival injection, a vascularized mass filling the retrolental space, and subconjunctival nodules at the sclerotomy sites. Enucleation was performed, and a mass was note to involve 95% of the posterior chamber without gross optic nerve invasion. Histopathologic examination confirmed malignant melanoma. The rapid, massive extrascleral extension of uveal melanoma through surgical sclerotomy sites demonstrated in this case has not been previously described.