Unsuspected uveal melanoma diagnosed after cataract extraction

Four cases of unsuspected uveal melanoma diagnosed after cataract extraction were found in a review of the records of enucleation specimens processed at our centre between 1974 and 1988. Similarities among the four cases included disparity in loss of visual acuity, unilateral angle-closure glaucoma, asymmetric cataract formation, inability to view the fundus and rapid flattening of the anterior chamber, with difficult closure at the time of surgery. Uveal melanoma should be suspected in any cataract patient presenting with one or more of these atypical clinical findings, and complete investigation, including A-scan and B-scan ultrasonography, is indicated.