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Purpose: Report of a case of retinal and vitreous metastases of a systemic melanoma, possibly arising in the lung, that responded favourably to radiotherapy. Case Report: Retinal and vitreous metastases were demonstrated in a 57-year-old woman during routine follow-up after surgical resection of a melanoma presumed to be a primary pulmonary melanoma. After a 7-week observation period, which confirmed the progressive nature of the intra-ocular lesions, the patient was treated by external beam radiotherapy at a dose of 35 Gy delivered in 14 fractions of 2.5 Gy. Complete disappearance of the vitreous invasion and progressive elimination of the retinal invasion were observed over a period of 9 months. Final visual function was 20/25. Review of Published Cases: A review of the literature identified 28 cases of melanoma with metastases to the retina and vitreous. In almost all of these cases, the primary tumour was a cutaneous melanoma and the mean patient survival following the diagnosis of intra-ocular metastases was 22 months. Retinal metastases, as in the case reported here, present a vascular tropism and tend to develop around veins. These metastases are generally unilateral and may be either solitary or multiple. Tumour invasion of the vitreous occurred by means of isolated cells forming a suspension of aggregates or spherules. Vitreous haemorrhage and irreducible neovascular glaucoma leading to functional impairment, which requires enucleation, were both the most frequent and the most serious complications of these metastases. Treatment is always palliative and is effective in cases with limited retinal and vitreous invasion, as in the case reported here. Conclusions: Metastatic melanoma in the retina and vitreous is a rare entity and can lead to functional impairment and enucleation because of neovascular glaucoma. As treatment is only effective in cases with limited invasion, systematic screening is recommended in all patients with a metastatic cutaneous melanoma presenting with suggestive ocular symptoms.

133 cases of uveal metastasis were reviewed. The study included 97 women and 36 men, aged 10 to 80 (mean 53.1). Breast carcinoma in women and lung carcinoma in men were the primary malignancies, which most frequently led to uveal metastasis. Metastasis from lung carcinoma were often diagnosed before the primary tumor. Survival from ocular diagnosis to death depends on the histological type of the primary tumor.

Maintaining successful mydriasis is essential during cataract extraction. The use of nonsteroidal anti-inflammatory drugs in order to inhibit trauma induced miosis has been advocated by many authors. Indomethacin 1% has proved his efficacy since many years. Flurbiprofen has been introduced more recently and has been accepted largely because of a better patient comfort. He proved his efficacy against placebo. We conducted a randomized double blind study in order to verify if there is any difference in efficacy between these two drugs. 40 cases were randomly assigned to a pretreatment, not known by the surgeons, with Indomethacin 1% (Indoptic) or Flurbiprofen 0.03% (Ocuflur). Measurements were taken at the beginning of surgery, after nucleous extraction and after irrigationaspiration of lens cortical material. Sodium hyaluronate and epinephrine were not used during this study. After nucleous extraction, the mean pupillary constriction was 1.53 mm in the Indomethacin group and 1.23 mm in the Flurbiprofen group (p greater than 0.1). After aspiration of cortical material, the mean pupillary constriction was 2.27 mm in the Indomethacin group and 2.00 in the Flurbiprofen group (p greater than 0.1). Cumulative results of patients who constricted the pupil more than 2 and 3 mm showed a better result in the Flurbiprofen group. Flurbiprofen has proved in this study his efficacy compared to an other nonsteroidal anti-inflammatory drug in inhibiting trauma induced miosis.