==== Front Indian J OphthalmolIndian J OphthalmolIJOIndian Journal of Ophthalmology0301-47381998-3689Medknow Publications & Media Pvt Ltd India IJO-66-123010.4103/ijo.IJO_565_18Letters to the EditorComment on: A rare case of unilateral diffuse melanocytic proliferation Dogra Mohit Singh Simar Rajan Singh Ramandeep Dogra Mangat Ram Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India Correspondence to: Dr. Mohit Dogra, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh - 160 012, India. E-mail: mohit_dogra_29@hotmail.com8 2018 66 8 1230 1230 Copyright: © 2018 Indian Journal of Ophthalmology2018This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. ==== Body Sir, We read with great interest the case report by Ayachit et al.[1] describing unilateral presentation of diffuse uveal melanocytic proliferation (DUMP) syndrome. The authors must be complemented on immaculate documentation of this rare case with multimodal imaging. However, a couple of areas need clarification. Oral tamoxifen was started for this patient with biopsy-proven metastatic breast cancer as the tumor had estrogen and progesterone receptor (PR) positivity. Tamoxifen has been shown to be the treatment of choice for postmenopausal females with PR-positive metastatic breast cancer.[2] How did the primary site respond to chemotherapy? If the tumor reduced in size after chemotherapy, is it not possible that the paraneoplastic syndrome associated with it would also reduce in severity/intensity? Second, DUMP is a paraneoplastic phenomenon and hence to institute intravitreal bevacizumab (IVB) therapy for this entity defies logic. Furthermore, regression shown by the authors on optical coherence tomography is after 2 months after starting tamoxifen and IVB. The authors site the report by Lin et al., in which the efficacy of IVB for choroidal metastasis due to colon cancer is highlighted.[3] DUMP is distinct from metastasis and occurs due to distant effect of the primary tumor. To ascribe the resolution of subretinal fluid and improvement of visual acuity solely to IVB would be incorrect, especially when it is known that even plasmapheresis/steroids do not work in most cases of DUMP.[45] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. ==== Refs 1 Ayachit G Ayachit A Joshi S Vasudevan SV A rare case of unilateral diffuse melanocytic proliferation Indian J Ophthalmol 2018 66 588 90 29582831 2 Bergh J Jönsson PE Glimelius B Nygren P SBU-group Swedish Council of Technology Assessment in Health Care. A systematic overview of chemotherapy effects in breast cancer Acta Oncol 2001 40 253 81 11441936 3 Lin CJ Li KH Hwang JF Chen SN The effect of intravitreal bevacizumab treatment on choroidal metastasis of colon adenocarcinoma – case report Eye (Lond) 2010 24 1102 3 19893587 4 Schelvergem KV Wirix M Nijs I Leys A Bilateral diffuse uveal melanocytic proliferation with good clinical response to plasmapheresis and treatment of the primary tumor Retin Cases Brief Rep 2015 9 106 8 25383840 5 Moreno TA Patel SN Comprehensive review of treatments for bilateral diffuse uveal melanocytic proliferation: A focus on plasmaphereis Int Ophthalmol Clin 2017 57 177 94 27898623