Optic disc melanocytoma associated with epiretinal membrane: a 5-year follow-up case report

Optic disc melanocytoma (ODM) is a rare benign pigmented tumor of the optic disc that usually has a favorable prognosis. Epiretinal membrane (ERM) associated with ODM has been reported only rarely, and longitudinal changes and surgical decision-making in such cases remain insufficiently described. A 74-year-old man with a 20-year history of a pigmented optic disc lesion in the left eye presented with progressive metamorphopsia and visual decline over approximately five years. Best-corrected visual acuity decreased from 20/50 to 20/200. Multimodal imaging showed a densely pigmented optic-disc-centered lesion with feathery margins, persistent blocked fluorescence, high internal reflectivity on B-scan ultrasonography, and anterior surface hyperreflectivity with posterior shadowing on optical coherence tomography, supporting a clinical diagnosis of presumed ODM. Longitudinal optical coherence tomography demonstrated progressive ERM-associated traction, increasing central macular thickness from 449 to 668 μm, cystoid intraretinal changes, distortion of the foveal contour, and disruption of the foveal ellipsoid zone. Cataract surgery did not improve visual acuity, although postoperative inflammation or pseudophakic cystoid macular edema may have contributed to the further increase in macular thickness. Vitrectomy with ERM peeling was considered to have a reasonable indication. However, complete posterior vitreous detachment had probably not occurred, and surgical separation of the posterior hyaloid near the tumor raised a theoretical concern regarding disruption of the tumor–vitreous interface and vitreous seeding. After repeated discussion of the potential benefits, risks, and uncertainties, the patient declined surgery and chose continued observation. This case documents five-year progressive tractional macular changes and visual decline in an eye with presumed ODM and a visually significant ERM. When complete posterior vitreous detachment is absent, surgical decision-making may be particularly complex and should be individualized according to the extent of macular damage, the vitreoretinal relationship around the tumor, and the patient’s preferences.