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Case Reports
. 2018 May 26:11:56-60.
doi: 10.1016/j.ajoc.2018.05.009. eCollection 2018 Sep.

Iris melanoma presenting as childhood glaucoma

Briana C Gapsis  1 , Nichelle A Warren  1 , Matthew J Nutaitis  1 , Leah A Bonaparte  1 , Samuel L Cooper  2 , Michael Ashenafi  2 , Hans E Grossniklaus  3 , George N Magrath  1
Affiliations
Case Reports

Iris melanoma presenting as childhood glaucoma

Briana C Gapsis et al. Am J Ophthalmol Case Rep. .

Abstract

Purpose: To describe the natural history and management of a rare case of iris melanoma in a pediatric patient.

Observations: A Caucasian female presented with left pupillary abnormalities at age 7, progressive iris changes at age 9, and markedly elevated intraocular pressure with advanced optic nerve cupping at 11 years of age. She was found to have a pigmented lesion overlying her iris and invading her angle. Trans-corneal fine needle aspirate biopsy demonstrated malignant melanoma of the iris. The patient subsequently underwent Iodine-125 plaque brachytherapy for the tumor.

Conclusions: and Importance: Early identification and treatment of iris melanoma may be associated with decreased risk of local progression and metastatic disease. Treatment of glaucoma in conjunction with uveal melanoma is complicated by tumor specific considerations, including treatment of the tumor and prevention of metastasis.

Keywords: Glaucoma; Iris melanoma; Pediatric.

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Figures

Fig. 1
Fig. 1
(A) External examination revealed a normal right eye but (B) demonstrated marked abnormalities of the left iris, including uveal ectropion, corectopia, and multiple patches of tapioca-like tissue overlying the iris. Magnified views of the left iris further illustrate the (C) uveal ectropion and (D) overlying iris membrane. The membrane limits the view of the prominent underlying blood vessels.
Fig. 2
Fig. 2
Bilateral fundus examination revealed (A) normal findings in the right eye and (B) marked cupping of the left optic nerve with nasalization of vessels and excavation of the optic disc rim.
Fig. 3
Fig. 3
Ultrasound biomicroscopy demonstrates (A) mild thickening of the iris nasally and (B) marked thickening of the iris temporally with iridolenticular and iridotrabecular contact with occlusion of the angle.
Fig. 4
Fig. 4
Anterior segment fluorescein angiogram demonstrates (A) radial iris vasculature with peripupillary perfusion irregularity superonasally in the left eye and (B) hyperfluorescence temporally and inferiorly. Enlargements of the areas of hyperfluorescence (C) inferonasally and (D) inferotemporally suggest increased regional perfusion with staining or leaking.
Fig. 5
Fig. 5
Trans-corneal fine needle aspiration biopsy of the iris lesion demonstrated a paucicellular aspirate with rare atypical cells with nuclear enlargement, prominent nucleoli, and wispy cytoplasm that was consistent with melanoma of the iris.
See this image and copyright information in PMC

References

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