Optical coherence tomography angiography of iris microhemangiomatosis

Abstract

Purpose: To report optical coherence tomography angiography (OCTA) of iris microhemangiomatosis.

Observations: A 75-year-old asymptomatic Caucasian man was found to have bilateral pupillary vascular lesions during cataract evaluation. Visual acuity was counting fingers in the right eye (OD) and 20/40 in the left eye (OS) with normal intraocular pressures in both eyes (OU). In each eye there were multifocal, round, dark red, pinpoint vascular tufts at the pupillary margin, randomly distributed and numbering 1 in OD and 7 in OS, each measuring 0.2-0.3 mm in diameter and without active bleeding or hyphema. Fundus examination OU was normal. By fluorescein angiography, the multifocal pupillary vascular tufts demonstrated mild staining without leakage. By OCTA, the tufts were clearly delineated and were fed by normal appearing radial iris vessels. OCT b-scan documented the optically dense vascular tufts at 0.1 mm in thickness and angio-overlay confirmed blood flow emanating from the deep iris stroma. Observation was recommended with the option of cataract surgery to improve vision.

Conclusions and importance: Non-invasive imaging of iris microhemangiomatosis with OCTA delineates the vascular lesion with flow arising from the posterior iris stroma.

Keywords: Fluorescein angiography; Iris microhemangiomatosis; OCT; OCTA; Optical coherence tomography angiography.

Fig. 1

A 75-year old Caucasian man with bilateral iris microhemangiomatosis. Slit-lamp photograph (A) of the left eye revealed multifocal iris microhemangiomatosis, each manifesting as a pinpoint red tuft at the pupillary margin (arrows). On optical coherence tomography angiography (OCTA) (B), six tightly coiled vascular tufts (arrows) are noted, fed by non-dilated iris vessels. OCT b-scan (C) through one of the lesions demonstrated an optically dense tuft resting on the lens with normal iris stroma and iris pigmented epithelium. OCT b-scan with flow overlay (red) (D) confirmed the vascular flow within the mass, originating from the deep iris stroma. The flow, seen at the iris pigmented epithelium level, could be projection artifact and could represent flow in the stroma more superficially. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)