Choroidal Melanoma leading to Enucleation

This is a montage color fundus photograph from the left eye of a 48-year-old woman with a choroidal melanoma. The tumor measured 10mm X 18mm X 18.7mm by ultrasonography and had low internal reflectivity and no extrascleral extension. There was a secondary serous retinal detachment. The examining ophthalmologist recommended enucleation based on the large size (> 16 mm greatest basal diameter), but the patient sought a second opinion, and the secondarily consulted physician agreed to treat the eye with I-125 brachytherapy, warning of a significant probability of complications including neovascular glaucoma.