• DOI:10.1167/IOVS.05-1435
• Corpus ID: 26298227

Optic nerve invasion of uveal melanoma: clinical characteristics and metastatic pattern.

@article{Lindegaard2006OpticNI,
  title={Optic nerve invasion of uveal melanoma: clinical characteristics and metastatic pattern.},
  author={Jens Lindegaard and Peter Isager and Jan Ulrik Prause and Steffen Heegaard},
  journal={Investigative ophthalmology \& visual science},
  year={2006},
  volume={47 8},
  pages={
          3268-75
        }
}

• J. Lindegaard, P. Isager, +1 author S. Heegaard
• Published 1 August 2006
• Medicine
• Investigative ophthalmology & visual science

PURPOSE
To determine the frequency of optic nerve invasion in uveal melanoma, to identify clinical factors associated with optic nerve invasion, and to analyze the metastatic pattern and the association with survival.

METHODS
All iris, ciliary body, and choroidal melanomas (N = 2758) examined between 1942 and 2001 at the Eye Pathology Institute, University of Copenhagen, Denmark, and the Institute of Pathology, Aarhus University Hospital, Aarhus, Denmark, were reviewed. Cases with optic nerve invasion were identified and subdivided into prelaminar or laminar invasion and postlaminar invasion. Clinical characteristics were compared with those from 85 cases randomly drawn from all ciliary body and choroidal melanomas without optic nerve invasion from the same period. Survival data were obtained by the Kaplan-Meier method, and the Mantel-Cox log-rank test was used to test differences in survival among the three patient groups.

RESULTS
Optic nerve invasion was found in 157 uveal melanomas (5.7%; 95% confidence interval [CI], 4.8%-6.6%). Frequency varied during the observation period between 5% and 7%. Only choroidal and ciliary body melanomas were found to invade the optic nerve. Eighty-five (54%) were confined to the prelaminar or laminar part, and 72 (46%) were confined to the postlaminar part. Increased intraocular pressure (IOP) and juxtapapillary location were associated with prelaminar or laminar invasion and postlaminar invasion. Age older than 70 years, reduced vision to light perception or worse, nonvisible fundus, and large (>15 mm) tumor size were associated with postlaminar spread. In univariate analysis, patients with postlaminar invasion had significantly higher all-cause and melanoma-related mortality than the other patients.

CONCLUSIONS
Optic nerve invasion in uveal melanoma is found in 1 in 20 patients. Visible juxtapapillary melanoma or loss of light perception should make the clinician suspicious of melanoma with optic nerve invasion, and special awareness of postlaminar spread should be addressed when increased IOP is present independently of decreased visual acuity and tumor location.