# Scleral communication between Glaucoma drainage device capsule and the suprachoroidal space simulating amelanotic choroidal melanoma

## TL;DR

A patient with a glaucoma drainage device developed a choroidal detachment that mimicked a rare eye tumor, but it was actually caused by a fistula from the device.

## Contribution

This is the first reported case of a drainage device fistula simulating amelanotic choroidal melanoma.

## Key findings

- A choroidal detachment was found to simulate amelanotic choroidal melanoma due to a fistula from a drainage device.
- The patient regained improved visual acuity after surgical intervention.
- Ultrasound imaging confirmed the transscleral communication and choroidal detachment.

## Abstract

This is a case report involving a 56-year-old male patient with a history of pars
plana vitrectomy due to a rhegmatogenous retinal detachment in the right eye
that resulted in the implantation of a drainage device after the patient
developed secondary glaucoma. Two years after the device’s implantation, the
patient was referred to our care as his visual acuity had decreased to 20/200
(1.00 LogMAR). At the fundus evaluation, a choroidal amelanotic elevation was
observed at the upper temporal equator, and a potential diagnosis was made of
amelanotic choroidal melanoma. The ultrasound exam visualized the patient’s
implanted superotemporal justabulbar drainage device, which revealed a
transscleral communication from the plate fibrocapsular’s draining space to the
suprachoroidal space (fistula). The ultrasound also revealed a focal pocket of
choroidal detachment in the patient’s superotemporal region, simulating an
amelanotic choroidal melanoma. A new pars plana vitrectomy was performed to
remove the internal limiting membrane without repercussions at the fistula site.
The patient’s recovery progressed well, and he regained a visual acuity of 20/70
(0.55 LogMAR). To the best of our knowledge, this is the first case report of
this condition.