1
|
Kim BZ, Lim JZ, McGhee CNJ. Cysts and tumours of the iris: Diagnostic tools and key management considerations-A review. Clin Exp Ophthalmol 2024; 52:665-683. [PMID: 38577954 DOI: 10.1111/ceo.14380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 03/24/2024] [Accepted: 03/24/2024] [Indexed: 04/06/2024]
Abstract
The iris is a unique structure, with exquisite variations in colour and form. Pathological changes, specifically including iris cysts and tumours are relatively uncommon, difficult to diagnose, and yet potentially blinding or life-threatening. Based on a comprehensive literature review, with highly illustrated key case examples, this report aims to guide the clinician in filtering the differential diagnoses of iris cysts and tumours. Evaluation is in the context of key diagnostic clinical tools and management considerations. Diagnostic imaging techniques include serial anterior segment photography, ultrasound, anterior segment optical coherence tomography, and iris fluorescein angiography, however, the roles of computerised topography and magnetic resonance imaging are also considered in this review. Management includes categorisation in terms of solid iris tumours (melanocytic vs. non-melanocytic), or iris cysts (primary vs. secondary) that may be usefully differentiated by clinical assessment, avoiding more invasive interventions. Cystic lesions are generally benign, although implantation cysts in particular cause significant complications and surgical challenges. Most solid tumours are melanocytic and also typically benign. However, in larger lesions, rapid growth, symptoms and complications more likely indicate malignancy, requiring further investigation.
Collapse
Affiliation(s)
- Bia Z Kim
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Ophthalmology, Greenlane Eye Clinic, Health New Zealand (Te Whatu Ora) Auckland, Auckland, New Zealand
| | - Joevy Z Lim
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Ophthalmology, Greenlane Eye Clinic, Health New Zealand (Te Whatu Ora) Auckland, Auckland, New Zealand
| | - Charles N J McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Ophthalmology, Greenlane Eye Clinic, Health New Zealand (Te Whatu Ora) Auckland, Auckland, New Zealand
| |
Collapse
|
2
|
McGrath LA, Warrier SK, Glasson WJ, D'Mellow MG, Hamilton HR, Palmer JM, Brooks KM, Johansson PA, Hayward NK. Iris melanoma in an Australian cohort. Clin Exp Ophthalmol 2024. [PMID: 39048918 DOI: 10.1111/ceo.14424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 06/23/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND To report the clinicopathological features and epidemiology of iris melanoma in Queensland, Australia. METHODS This was a retrospective study of 86 patients with iris melanoma treated between 2001 and 2022 at the Queensland Ocular Oncology Service, Brisbane, Australia. Main outcome measures included demographics, clinical and phenotypic features, age-adjusted incidence and relative survival. RESULTS Eighty-six patients (63% female) were included. Mean age was 54 years (range 17-82 years). The majority of patients (97%) were Caucasian, with blue eyes, fair skin and Fitzpatrick Skin Type I or II. Demographic features and clinical history showed a tendency for high ultraviolet radiation (UVR) exposure in the cohort. Histopathology was available in 69 cases (82%), and of these, 77% tumours were of spindle cell origin, with low-risk genetic profiles. Patients were followed for a mean of 8 years (median 7, range 1-21 years) after diagnosis, and only one case of metastasis was documented. CONCLUSIONS The association of iris freckles, history of UVR exposure and dermatologic findings supports the role of UVR in iris melanoma. Occupation and avocation history, as well as evaluation of iris freckles may offer an easily accessible way of stratifying the risk of an individual for development of UVR-related uveal melanoma.
Collapse
Affiliation(s)
- Lindsay A McGrath
- Terrace Eye Centre, Queensland Ocular Oncology Service, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Sunil K Warrier
- Terrace Eye Centre, Queensland Ocular Oncology Service, Brisbane, Australia
| | - William J Glasson
- Terrace Eye Centre, Queensland Ocular Oncology Service, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Matthew G D'Mellow
- Terrace Eye Centre, Queensland Ocular Oncology Service, Brisbane, Australia
- Oncogenomics Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Hayley R Hamilton
- Oncogenomics Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Jane M Palmer
- Oncogenomics Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Kelly M Brooks
- Oncogenomics Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Peter A Johansson
- School of Medicine, University of Queensland, Brisbane, Australia
- Oncogenomics Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Nicholas K Hayward
- Oncogenomics Laboratory, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| |
Collapse
|
3
|
Singh A, Melendez-Moreno A, Krohn J, Zabor EC. Predictive model for iris melanoma. Br J Ophthalmol 2024:bjo-2023-324558. [PMID: 38609162 DOI: 10.1136/bjo-2023-324558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 03/17/2024] [Indexed: 04/14/2024]
Abstract
AimTo develop a predictive model for the diagnosis of iris melanoma. METHODS Retrospective consecutive case series that included 100 cases of pathologically confirmed iris melanoma and 112 cases of Iris naevus, either pathological confirmation or documented stability of >1 year. Patient demographic data, features of clinical presentation, tumour characteristics and follow-up were collected. Iris melanoma with ciliary body extension was excluded. Lasso logistic regression with 10-fold cross-validation was used to select the tuning parameter. Discrimination was assessed with the area under the curve (AUC) and calibration by a plot. RESULTS There was a significant asymmetry in the location of both nevi and melanoma with preference for inferior iris quadrants (83, 74%) and (79, 79%), respectively (p=0.50). Tumour seeding, glaucoma and hyphaema were present only in melanoma. The features that favoured the diagnosis of melanoma were size (increased height (OR 3.35); increased the largest basal diameter (OR 1.64)), pupillary distortion (ectropion uvea or corectopia (OR 2.55)), peripheral extension (angle or iris root involvement (OR 2.83)), secondary effects (pigment dispersion (OR 1.12)) and vascularity (OR 6.79). The optimism-corrected AUC was 0.865. The calibration plot indicated good calibration with most of the points falling near the identity line and the confidence band containing the identity line through most of the range of probabilities. CONCLUSIONS The predictive model provides direct diagnostic prediction of the lesion being iris melanoma expressed as probability (%). Use of a prediction calculator (app) can enhance decision-making and patient counselling. Further refinements can be undertaken with additional datasets, forming the basis for automated diagnosis.
Collapse
Affiliation(s)
- Arun Singh
- Department of Ophthalmic Oncology, Cleveland Clinic Main Campus Hospital, Cleveland, Ohio, USA
| | | | - Jørgen Krohn
- Department of Clinical Medicine, Bergen University College, Bergen, Norway
- Department of Ophthalmology, Haukeland University Hospital, Bergen, Norway
| | - Emily C Zabor
- Department of Quantitative Health Sciences & Taussig Cancer Institute, Cleveland Clinic Main Campus Hospital, Cleveland, Ohio, USA
| |
Collapse
|
4
|
Cherkas E, Kalafatis NE, Marous MR, Shields CL. Iris melanoma: Review of clinical features, risks, management, and outcomes. Clin Dermatol 2024; 42:62-70. [PMID: 37865279 DOI: 10.1016/j.clindermatol.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Primary uveal melanoma is rare and affects approximately 8,000 persons per year worldwide. This malignancy can involve the iris, ciliary body, and choroid. Of these three structures, the iris is the least commonly affected site, representing only 4% of all uveal melanomas. Iris melanoma can arise from iris melanocytic nevus, iris melanocytosis, or de novo. In a longitudinal study of 1,611 patients with iris nevus, transformation into melanoma, using Kaplan-Meier estimates, was found in 2.6% by five years and in 4.1% by 10 years. The factors that predicted growth of iris melanocytic nevus into melanoma are denoted by a letter (ABCDEF) guide: A for age ≤40 years old at presentation (hazard ratio [HR] = 3, P = .01), B for blood (hyphema) (HR = 9, P < .0004), C for clock hour of tumor inferiorly (tumor location) (HR = 9, P = .03), D for diffuse flat tumor configuration (HR = 14, P = .02), E for ectropion uveae (HR = 4, P = .002), and F for feathery ill-defined margins (HR = 3, P = .02). At diagnosis, iris melanoma has a mean cross-sectional diameter of 5.5 mm and thickness of 2.1 mm, often with tumor seeding (28%) and secondary glaucoma (35%). We provide a comprehensive review of iris nevus and melanoma to explore relevant demographic and clinical data, risk factors for tumor growth, management, and prognosis, with the hope that clinicians will be more comfortable in understanding this rare malignant condition.
Collapse
Affiliation(s)
- Elliot Cherkas
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nicholas E Kalafatis
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Molly R Marous
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York, USA
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
| |
Collapse
|
5
|
Eibenberger K, Heimann H, Gatchalian L, Kacperek A, Hussain R. Side Effects of Proton Beam Radiotherapy Treatment on Iris Melanoma. Ophthalmology 2023; 130:958-965. [PMID: 37169262 DOI: 10.1016/j.ophtha.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/07/2023] [Accepted: 05/03/2023] [Indexed: 05/13/2023] Open
Abstract
PURPOSE This study evaluated the functional outcome and ocular side effects of patients receiving proton beam radiotherapy (PBR) for the treatment of iris melanoma (IM). DESIGN This retrospective study analyzed prospectively collected data. PARTICIPANTS Patients with IM who underwent PBR as a primary treatment. METHODS Treatment was given in the form of whole PBR (wPBR: n = 51) or segmental PBR (sPBR: n = 98). MAIN OUTCOME MEASURES Visual acuity (VA) and side effects were divided into ocular surface disease (OSD), secondary glaucoma, or cataract development. RESULTS A total of 149 eyes of 149 patients with a mean age of 53.9 ± 16.0 years were included. Tumor recurrence developed in 3 patients (wPBR: 1/51; sPBR: 2/98). Ocular surface disease was observed in 78.4% of the wPBR group (40/51) and 25.5% of the sPBR group (25/98) (P < 0.001) after 0.7 ± 1.2 years and 1.1 ± 0.9 years, respectively. The main side effect was dry eye syndrome in both groups, but severe side effects such as limbal stem cell failure were found only in the wPBR group (4/51; 7.8%). Secondary glaucoma developed in 31.4% of the wPBR group (16/51) compared with 1.0% in the sPBR group (1/98; P < 0.001). Glaucoma control was generally achieved with eye drops, whereas surgery was necessary in 5 patients (wPBR: 4/51, 7.8%; sPBR: 1/98, 1%). Cataract surgery was performed in 47.9% of the wPBR group (23/48) and 19.8% of the sPBR group (19/96) (P < 0.001). Before treatment, VA was 0.14 ± 0.27 logarithm of the minimum angle of resolution (logMAR) in the wPBR group and 0.04 ± 0.19 logMAR in the sPBR group. A worsening was seen in the wPBR group (0.55 ± 0.16 logMAR; P < 0.001) 6 months after radiotherapy, which normalized after 12 months (0.15 ± 0.30 logMAR; P = 0.17). In the sPBR group, no such decrease in VA was observed (6 months: 0.03 ± 0.22 logMAR, P = 0.54; 12 months: 0.04 ± 0.21 logMAR, P = 0.98). CONCLUSIONS Our results demonstrate that PBR is a very successful treatment option for patients with IM, showing a high tumor control rate and relatively low complication profile. Tumor recurrence was a rare event, and secondary enucleation was not necessary in any patient. Side effects are commonly seen, but severe side effects such as limbal stem cell failure or secondary glaucoma mainly developed after wPBR. These results are important for clinical decision making and discussion with the patient regarding this form of radiotherapy. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Collapse
Affiliation(s)
- Katharina Eibenberger
- Liverpool Ocular Oncology Centre, Liverpool University Hospitals Trust, Liverpool, United Kingdom
| | - Heinrich Heimann
- Liverpool Ocular Oncology Centre, Liverpool University Hospitals Trust, Liverpool, United Kingdom; Liverpool Ocular Oncology Research Group, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Leandro Gatchalian
- Liverpool Ocular Oncology Centre, Liverpool University Hospitals Trust, Liverpool, United Kingdom
| | - Andrzej Kacperek
- The Clatterbridge Cancer Centre, Bebington, Wirral, United Kingdom
| | - Rumana Hussain
- Liverpool Ocular Oncology Centre, Liverpool University Hospitals Trust, Liverpool, United Kingdom; Liverpool Ocular Oncology Research Group, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom.
| |
Collapse
|
6
|
Singaravelu J, Melendez-Moreno A, Wrenn J, Singh AD. Angiographic Features of Iris Melanocytic Tumors: Nevus versus Melanoma. Ocul Oncol Pathol 2023; 9:9-16. [PMID: 37600848 PMCID: PMC10433095 DOI: 10.1159/000529073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/26/2022] [Indexed: 08/22/2023] Open
Abstract
Introduction Determining the nature of iris melanocytic tumors based on clinical exam alone remains challenging. Tumor-associated vasculature of iris melanocytic lesions may facilitate the ability to discern between iris nevus and melanoma. Methods In a single-institution, retrospective, observational study of 45 patients with pathologically confirmed iris melanoma and 15 patients with iris nevi that were either clinically stable or pathologically confirmed were included. Tumor characteristics and associated vasculature were identified on clinical exam and slit-lamp photographs. Fluorescein angiographic parameters including feeder vessels, intrinsic vessels, leakage, masking, and angiographic silence were assessed. Results Feeder vessels were present in 17 (43%) melanomas and were absent in the nevus group (p = 0.002). Thirty-three (83%) iris melanomas and 5 (33%) iris nevi were observed to have intrinsic vessels, and a statistically significant association of intrinsic vessels with malignancy (p = 0.001) was noted. Fluorescein leakage was also observed more frequently in iris melanoma 39 (98%) than in nevi 9 (60) with a significant difference (p = 0.001). Angiographic silence occurred in 3 nevi (20%) and was not observed in any melanoma (p = 0.017). Overall, the presence of intrinsic vessels +/- feeder vessels had high sensitivity (0.85) and high positive predictive value (0.87) for diagnosis of iris melanoma. Conclusions Anterior segment fluorescein angiography allows for the assessment of tumor-associated vascular patterns and demonstrates utility in differentiating iris nevi from melanoma. Feeder vessels were only observed in iris melanoma and were absent in iris nevi. The intrinsic vessels were present more frequently in melanomas and are thus associated with malignancy. Angiographic silence is indicative of iris nevi.
Collapse
Affiliation(s)
| | | | | | - Arun D. Singh
- Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
7
|
Gollrad J, Böker A, Vitzthum S, Besserer A, Heufelder J, Gauger U, Böhmer D, Budach V, Zeitz O, Joussen AM. Proton Therapy for 166 Patients with Iris Melanoma: Side Effects and Oncologic Outcomes. Ophthalmol Retina 2023; 7:266-274. [PMID: 36087876 DOI: 10.1016/j.oret.2022.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/22/2022] [Accepted: 08/26/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the oncologic and functional outcomes of a large cohort of patients with a favorable stage of circumscribed and diffuse iris melanoma who underwent primary proton treatment and the risk factors related to initial tumor characteristics and the treatment field architecture. DESIGN Retrospective, single-center, case study. PARTICIPANTS We reviewed 225 patients with iris melanoma who were consecutively treated with proton beam therapy at our institution between 1998 and 2020. METHODS We performed Kaplan-Meier time-to-event analyses and multivariate Cox proportional hazard analyses to identify the impacts of tumor characteristics and target volumes on oncologic and functional outcomes. MAIN OUTCOME MEASURES We measured local tumor control, eye preservation rates, metastasis-free survival, cataract and glaucoma-directed surgery, intraocular pressure, and changes in visual acuity. RESULTS Of the 192 patients with tumors confined to the iris (T1a-c) who underwent proton therapy as primary treatment, a total of 166 patients (mean age, 58.4 years; 88 women) with a minimum follow-up of 6 months were included. Multifocal or diffuse tumor spread was present in 77 (46.4%) patients. The median follow-up time was 54.0 (interquartile range, 27.4-91.8 months) months. Local recurrence occurred in 2 patients (1.2%) with circumscribed iris melanoma. Enucleation was a rare event (n = 5, 3%) and no patient developed metastatic disease. A large-treatment field (full aperture, involving > 10 clock hours) was identified as a risk factor for the development of secondary glaucoma (hazard ratio [HR], 6.3; P < 0.001) and subsequent surgical interventions (HR, 10.85; P < 0.001). The large-treatment field group showed a significant decline in visual acuity (logarithm of the minimum angle of resolution > 0.3; log-rank P < 0.0001), which was associated with secondary glaucoma (HR, 3.40; P = 0.002). CONCLUSIONS Proton therapy provides an effective, noninvasive treatment option for patients with a favorable stage of iris melanoma. Irradiation of the anterior segment for up to 10 clock hours is associated with a low risk of the development of secondary glaucoma and vision loss. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
Collapse
Affiliation(s)
- Johannes Gollrad
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Germany
| | - Alexander Böker
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Germany; Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Germany.
| | - Sebastian Vitzthum
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Germany
| | - Angela Besserer
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Germany
| | - Jens Heufelder
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Germany
| | - Ulrich Gauger
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Germany
| | - Dirk Böhmer
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Germany
| | - Volker Budach
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Germany
| | - Oliver Zeitz
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Germany
| | - Antonia M Joussen
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Germany
| |
Collapse
|
8
|
Iris melanocytic tumours in New Zealand/Aotearoa: presentation, management and outcome in a high UV exposure environment. Eye (Lond) 2023; 37:692-699. [PMID: 35338357 PMCID: PMC9998588 DOI: 10.1038/s41433-022-02017-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/09/2022] [Accepted: 03/04/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND/OBJECTIVES Iris melanoma, a rare intraocular malignancy, represents the smallest subgroup of uveal melanoma. This first, comprehensive study of iris melanocytic lesions in the high ultraviolet environment in New Zealand/ Aotearoa (NZ) examines diagnosis, management and outcomes. SUBJECTS/METHODS Retrospective study of iris melanocytic tumours referred to tertiary referral centres in Auckland, NZ, over 20 years (1999-2018). Data analysed include demographics, tumour characteristics, histology, genetic analyses, treatment modalities, recurrence, metastasis, 5-year and overall survival. RESULTS Cohort (N = 51) was predominantly NZ European (98.0%) with no indigenous Māori, or Pasifika. Median age at presentation was 58 years. Tumours involved a median of two clock hours of iris. The posterior tumour margin extended to the anterior chamber angle in 22 patients (45.8%). Management included initial observation 54.9%, iridectomy/excision biopsy 29.4%, irido-cyclectomy 7.8%, plaque radiotherapy 7.8%, proton beam radiotherapy 7.8%, and ultimately enucleation 17.6%. Histology was performed in 19 cases (37%) with 16 confirmed melanomas (84%). Mean follow-up 4.2 years with median visual acuity of 6/7.5 two years post intervention. Melanoma-related metastasis and mortality occurred in two cases with five-year melanoma-related mortality of 2.0%. CONCLUSION In a climate with high ultraviolet exposure iris melanocytic tumours occurred almost exclusively in NZ Europeans, however, the majority of cases were category T1, possibly reflecting early diagnosis in the NZ health system. Nonetheless, >50% underwent surgery or radiotherapy, often utilising more than one modality. A high index of suspicion and early referral of iris melanocytic lesions should be considered in regions with high UV exposure.
Collapse
|
9
|
Finley J, Evans WI, Kruglov A, Wilson MW. An unusual case of a pigment epithelial cyst masquerading as a uveal melanoma after zoster ophthalmicus-related iris atrophy. Am J Ophthalmol Case Rep 2023; 30:101818. [PMID: 36865090 PMCID: PMC9972488 DOI: 10.1016/j.ajoc.2023.101818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/02/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023] Open
Abstract
Purpose To report the case of a 69-year-old male who was referred for a previously unidentified pigmented iris lesion with surrounding iris atrophy masquerading as an iris melanoma. Observations A sharply demarcated pigmented lesion extending from the trabecular meshwork to the pupillary margin was identified in the left eye. There was adjacent iris stromal atrophy. Testing was consistent with a cyst-like lesion. The patient later described a prior episode of ipsilateral herpes zoster involving the ophthalmic division of cranial nerve five. Conclusions and Importance Iris cysts present an uncommon iris tumor, often going unrecognized especially if located on the posterior iris surface. When they present acutely, as in this case where a previously unidentified cyst was revealed following zoster-induced sectoral iris atrophy, these pigmented lesions can be concerning for malignancy. Accurately identifying iris melanomas and differentiating them from benign iris lesions is imperative.
Collapse
Affiliation(s)
- Jordan Finley
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USA
| | - William I. Evans
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Aleksandr Kruglov
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USA,Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Matthew W. Wilson
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USA,Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA,Corresponding author. Department of Ophthalmology, Director, Hamilton Eye Institute, USA.
| |
Collapse
|
10
|
Azarcon CP, Wells JR, Aaberg T, Grossniklaus HE. Intraocular Lens and Lens Capsule Spread of Iridociliary Melanoma: Clinical and Histopathologic Features of 2 Cases. Ocul Oncol Pathol 2022; 8:105-109. [DOI: 10.1159/000524052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/09/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose: To describe two patients with intraocular lens (IOL) and lens capsule spread of iridociliary melanoma.
Methods: Two pseudophakic patients with iridociliary body melanoma that spread onto the surface of their IOL and remaining lens capsule were included. Their eyes were enucleated and the histopathologic features were evaluated.
Results: Case 1 was an 82-year-old woman with diffuse primary iridociliary melanoma affecting the iris, lens capsule, IOL surface, and ciliary body. Case 2 was a 68-year-old female who developed melanoma recurrence in the anterior segment after plaque brachytherapy for iridociliary melanoma. The melanoma in both cases grew as a pigmented membrane onto the surface of the IOL.
Conclusions: Intraocular lens and lens capsule spread of iridociliary melanoma can occur primarily or develop secondarily after plaque brachytherapy of a pseudophakic eye. Since the extent of the melanoma may be uncertain and there is a high likelihood of glaucoma, enucleation is a reasonable option.
Collapse
|
11
|
Hauzinger JA, Blatsios G, Haas G, Zehetner C, Velez-Escola L, Nowosielski Y, Seifarth C, Rauchegger T, Haider B, Bechrakis NE. Proton beam radiation for iris melanoma: case series and review of literature. BMJ Open Ophthalmol 2022; 6:e000683. [PMID: 35018306 PMCID: PMC8705205 DOI: 10.1136/bmjophth-2020-000683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/27/2021] [Indexed: 11/12/2022] Open
Abstract
Objective Purpose of this study is to analyse the visual outcomes, the complication and eye retention rate as well as tumour control data of patients treated with proton beam radiation therapy (PBRT) for iris melanoma. Methods Retrospective case series and review based on patients’ records. All tumours were categorised according to the American Joint Committee of Cancer staging criteria for primary iris melanoma und underwent either sectorial or whole anterior segment PBRT. Results Thirteen cases were identified of which five received PBRT of the whole anterior segment and eight received sectorial PBRT. Local tumour control after a mean follow-up of 25 months was 92%. Complications after PBRT included cataract (46%), secondary glaucoma (31%), superficial keratitis (15%) and madarosis (8%). Complications were more common in patients necessitating irradiation of the entire anterior segment than in patients which received sectorial irradiation. Eye retention was achieved in all cases. No statistically significant difference in the mean best corrected visual acuity (BCVA) and intraocular pressure (IOP) was found before and after treatment. Comparison of mean BCVA and IOP between different treatment groups (complete anterior segment vs sectorial irradiation) at the last follow-up visit were also not significantly different. No patient developed metastatic disease during follow-up. Conclusion PBRT is a safe and vision preserving therapeutic modality for iris melanoma. Complete irradiation of the anterior segment is associated with higher complication rates.
Collapse
Affiliation(s)
| | - Georgios Blatsios
- Department of Ophthalmology and Optometry, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Gertrud Haas
- Department of Ophthalmology and Optometry, Innsbruck Medical University, Innsbruck, Austria
| | - Claus Zehetner
- Department of Ophthalmology and Optometry, Innsbruck Medical University, Innsbruck, Austria
| | - Luisa Velez-Escola
- Department of Ophthalmology and Optometry, Innsbruck Medical University, Innsbruck, Austria
| | - Yvonne Nowosielski
- Department of Ophthalmology and Optometry, Innsbruck Medical University, Innsbruck, Austria
| | - Christof Seifarth
- Department of Ophthalmology and Optometry, Innsbruck Medical University, Innsbruck, Austria
| | - Teresa Rauchegger
- Department of Ophthalmology and Optometry, Innsbruck Medical University, Innsbruck, Austria
| | - Bernhard Haider
- Department of Radiology, Innsbruck Medical University, Innsbruck, Austria
| | | |
Collapse
|
12
|
Krohn J, Sundal KV, Frøystein T. Topography and clinical features of iris melanoma. BMC Ophthalmol 2022; 22:6. [PMID: 34980044 PMCID: PMC8725464 DOI: 10.1186/s12886-021-02236-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 12/22/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND To characterise the topographical and clinical features of primary iris melanoma and to visualise the patterns of tumour extent in the iris. METHODS Clinical characteristics of iris melanomas were analysed, and data on their size, shape, and location were converted into a database of two-dimensional iris charts by means of computer-drawing software. The geometric centre of each tumour was entered into corresponding sectors of the chart. The extent of the melanomas was computationally visualised by merging the iris drawings and displaying the number of overlapping tumours on colour-coded iris maps. RESULTS Twenty-nine patients (18 females and 11 males) with a mean age of 52 years met the inclusion criteria. The mean largest tumour diameter was 6.1 mm (range, 1.8-11.0 mm). Five tumours (17%) involved the pupillary margin, 10 (34%) involved the iris root, and 10 (34%) involved both sites. The hemispheric location of the tumour centroid was superior in 3 eyes (11%) and inferior in 25 (89%) (p < 0.0001), and the distribution between the temporal and nasal hemispheres was 17 (61%) and 11 (39%), respectively (p = 0.26). In females, the iris melanomas were located more temporally (p = 0.02) and had more often originated from a pre-existing naevus (p = 0.03), than in males. There was also shift towards more temporally located melanomas in younger patients. CONCLUSIONS The lower temporal iris quadrant is the preferential area of melanoma occurrence and growth. Iris melanoma tends to be more temporally located in females, who compared with males also have a higher proportion of melanomas arising from a pre-existing naevus.
Collapse
Affiliation(s)
- Jørgen Krohn
- Department of Clinical Medicine, Section of Ophthalmology, University of Bergen, Bergen, Norway.
- Department of Ophthalmology, Haukeland University Hospital, N-5021, Bergen, Norway.
| | - Kristoffer Våge Sundal
- Department of Clinical Medicine, Section of Ophthalmology, University of Bergen, Bergen, Norway
| | - Torbjørn Frøystein
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
13
|
Branisteanu DC, Bogdanici CM, Branisteanu DE, Maranduca MA, Zemba M, Balta F, Branisteanu CI, Moraru AD. Uveal melanoma diagnosis and current treatment options (Review). Exp Ther Med 2021; 22:1428. [PMID: 34707709 PMCID: PMC8543295 DOI: 10.3892/etm.2021.10863] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/25/2021] [Indexed: 12/11/2022] Open
Abstract
Uveal melanoma is a rare condition accounting for only 5% of all primary melanoma cases. Still, it is the most frequently diagnosed primary intraocular malignant tumor in adults. Almost 90% of the tumors involve the choroid and only a small percentage affects the ciliary body or the iris. There is a consistent difference in incidence between different regions with individuals of northern European descent having a significantly higher risk as compared to Hispanics, Asians, and Blacks. Among the many risk factors, mutations in the G protein subunit alpha Q (GNAQ) or G protein subunit alpha 11 (GNA11) genes and different receptors are highly suggestive. While iris melanoma can easily be noticed by the patient itself or diagnosed at a routine slit-lamp evaluation, a consistent percentage of posterior uveal tumors are incidentally diagnosed at funduscopic evaluation as they can evolve silently for years, especially if located in the periphery. Uveal melanoma classifications rely on the tumor size (thickness and basal diameter) and also on intraocular and extraocular extension. The differential diagnosis with pseudomelanomas is carried out according to the tumor aspect and position. Iris melanoma has a better prognosis and a lower mortality rate as compared to choroidal melanoma that has a much higher rate of metastasis (50% of the patients) and a subsequent limited life expectancy from 6 to 12 months. While conservative therapeutic options for the primary tumor, relying on different surgical excision techniques and/or irradiation therapies, offer good local tumor control, the treatment options for metastatic disease, although numerous, are still inadequate in preventing a fatal outcome.
Collapse
Affiliation(s)
| | | | - Daciana Elena Branisteanu
- Department of Dermatology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Minela Aida Maranduca
- Department of Physiology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Mihail Zemba
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Florian Balta
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | | | - Andreea Dana Moraru
- Department of Ophthalmology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| |
Collapse
|
14
|
Relief of symptomatic pseudo-polycoria due to iris biopsy using a daily contact lens. Am J Ophthalmol Case Rep 2021; 22:101084. [PMID: 33898861 PMCID: PMC8056339 DOI: 10.1016/j.ajoc.2021.101084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 02/03/2021] [Accepted: 03/26/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose To report a case of pseudo-polycoria from iris biopsy managed by a daily disposable prosthetic colored hydrogel lens. Observations A 55-year-old- Caucasian female presented with complaints of photophobia in her right eye, that was exacerbated when going from a dark to light environment. Her past ocular history included a diagnosis by another outside physician of presumed multifocal iris melanoma in the right eye, followed by an iris biopsy performed one month later. Upon presentation to our clinic two months later, best corrected visual acuity was 20/20- in the right eye and 20/25 in the left eye. Slit lamp exam of the right eye revealed iris abnormalities, full-thickness biopsy defects at 2, 3 and 6 o'clock and a 0.8 × 0.7mm area of iris hyperpigmentation at 8 o'clock (Fig A,B,C, and D). The patient was provided with three non-surgical options to manage her symptoms: a commercially available soft daily replacement printed prosthetic hydrogel lens, a commercially available soft monthly replacement silicone printed prosthetic hydrogel lens, or a custom soft yearly replacement prosthetic hydrogel lens with dark inlay. The soft daily printed prosthetic hydrogel lens was chosen because of its ease in hygiene regimen and did not limit peripheral vision as the yearly dark inlay lens would. Results The patient now wears Alcon Dailies® Color, Base curvature 8.6, Diameter 13.8, color mystic green in the right eye and her symptoms of photophobia have been resolved (Figure F). Conclusion There are limited options to manage photophobia in patients with polycoria or pseudo-polycoria. Surgical intervention is dictated by how many quadrants of iris are involved and therefore how symptomatic a patient may be. A less invasive alternative to surgical intervention is the use of a contact lens. In this case, traditional hand painted or printed yearly or monthly replacement hydrogel contact lenses were not used. Instead, a daily disposable hydrogel was successfully fit, highlighting that there is often a simple solution to a seemingly complicated issue.
Collapse
|
15
|
Brouwer NJ, Marinkovic M, Bleeker JC, Luyten GP, Jager MJ. Anterior Segment OCTA of Melanocytic Lesions of the Conjunctiva and Iris. Am J Ophthalmol 2021; 222:137-147. [PMID: 32926848 DOI: 10.1016/j.ajo.2020.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE To study the feasibility and diagnostic value of vascular imaging using optical coherence tomography (OCT)-angiography (OCTA) of melanocytic lesions of the conjunctiva and iris. DESIGN Cross-sectional study. METHODS Twenty-five patients with an untreated conjunctival lesion (5 melanoma, 13 nevus, 7 primary acquired melanosis [PAM]) and 52 patients with an untreated iris lesion (10 melanoma, 42 nevus) were included. Patients were imaged using a commercially available OCTA device, with the addition of an anterior segment lens and manual focussing. Tumor vessel presence, vascular patterns and vascular density were assessed. RESULTS Good OCTA images were obtained in 18 of 25 conjunctival lesions and 42 of 52 iris lesions. Failure was caused by lack of patient cooperation, an unfavorable location, or mydriasis. In all imaged conjunctival lesions and 77% of iris lesions, vascular structures were detected. Conjunctival melanoma and nevi demonstrated the same intralesional tortuous patterns, whereas vasculature in eyes with PAM was similar to normal conjunctiva. Both iris melanoma and nevi demonstrated tortuous patterns, distinct from the radially oriented normal iris vasculature. CONCLUSIONS Optical coherence tomography angiography (OCTA) allows for noninvasive imaging of the vasculature in melanocytic lesions of the conjunctiva and iris. Good image quality depends highly on patient cooperation and lesion characteristics. Differentiation of benign and malignant lesions was not possible. New software is called for to improve image acquisition and analysis.
Collapse
|
16
|
Abstract
Iris melanomas represent 2–5% of uveal melanomas. Iris melanomas vary in their size, shape, degree of pigmentation and clinical behavior. The main local clinical complications of iris melanomas are tumor vascularization, ectropion uvea, pupillary distortion, pigment dispersion, sector cataract, chronic uveitis, hyphema and glaucoma with irreversible optic nerve damage. The most effective treatment for iris nevus and melanoma remains debatable; treatment modalities have been proposed depending on the local status as well as the age and general condition of the patient. A melanocytic iris nevus is usually observed until documented progression is identified. In this case, radiotherapy or surgical resection is generally performed. Cataract, glaucoma and limbal stem cell deficiency are usually secondary to radiotherapy, while incomplete tumor excisions, which could lead to recurrence, hemorrhage, vitreous loss, dislocated lens, iridocyclitis, macular edema, retinal detachment, glaucoma and cataract, are related to surgical resection. In some cases, a combination of radiotherapy and surgery is used. Conservative treatment is an efficient alternative to enucleation and allows good local tumor control.
Collapse
|
17
|
Masoomian B, Saatchi M, Ghassemi F, Riazi-Esfahani H, Vahedian Z. Angle Closure Glaucoma Secondary to Enlarged Soemmering Ring That is Clinically Similar to Iris Tumour. Int Med Case Rep J 2020; 13:327-330. [PMID: 32801945 PMCID: PMC7415444 DOI: 10.2147/imcrj.s263299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/17/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose To report a case of a grown Soemmering ring that manifested as an iris tumour 24 years after cataract surgery. Methods A case report. Results A 27-year-old white man was presented with a suspected iris tumour in his left eye. He had undergone lensectomy in both eyes without intraocular lens implantation 24 years ago. Last year, he was treated by topical anti-glaucoma medication for left eye intraocular pressure (IOP) rising. Six months later, his ophthalmologist found two separate iris bumps. The patient was referred to an ocular oncologist and was to be treated with plaque brachytherapy as iris melanoma, but he denied. Ultrasound biomicroscopy (UBM) of the left eye showed significant angle narrowing due to separate ovoid hyper echoic masses behind the iris, which was clearly separated from the ciliary body. Retained and growth lens material caused a Soemmering ring to enlarge, which was the reason for glaucoma and iris bumping. The patient has been followed for more than one year without any changes being observed. Conclusion An enlarged and grown Soemmering ring should be considered in the differential diagnosis of any iris and ciliary body tumour, especially in patients who have had cataract surgery.
Collapse
Affiliation(s)
- Babak Masoomian
- Ocular Oncology Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Saatchi
- Ocular Oncology Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Ghassemi
- Ocular Oncology Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Riazi-Esfahani
- Ocular Oncology Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zakieh Vahedian
- Ocular Oncology Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
18
|
Conservative management of suspicious melanocytic lesions of the iris. Graefes Arch Clin Exp Ophthalmol 2019; 257:1319-1324. [DOI: 10.1007/s00417-019-04296-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/27/2019] [Accepted: 03/12/2019] [Indexed: 12/15/2022] Open
|
19
|
Abstract
BACKGROUND Benign iridal tumors rarely necessitate a therapeutic intervention. In contrast, malignant tumors of the iris can threaten the patient's life and eyesight and require early treatment to prevent the development of metastases. OBJECTIVE Presentation of current treatment options for iridal tumors with special emphasis on iridal melanoma. METHODS This article gives an overview of the current literature based on a PubMed search as well as own clinical experience. RESULTS Treatment options for iridal and ciliary body melanomas comprise radiotherapeutic and surgical (eyeball-sparing and non-sparing) approaches. The eyeball-sparing surgical procedure of choice is block excision. While local tumor control rates and metastasis rates of block excision and radiotherapy are comparable, there are distinct differences especially between the spectra of complications. New treatment procedures include immunomodulatory approaches and targeted therapies. Using checkpoint inhibitors, no convincing enhancement of overall survival could be demonstrated for metastatic iridal melanoma, as is the case for cutaneous melanoma. In contrast, tumor vaccination with the help of tumor RNA-laden patient-derived dendritic cells seems to be a promising option for a subgroup of high-risk patients. Targeted therapies aiming to suppress the MAPK and PI3K/Akt pathways could not achieve any improvement in patient survival. CONCLUSION For the primary treatment of iridal melanoma a surgical, eyeball-sparing approach and also when appropriate, radiotherapy can be recommended. In the future, eligible high-risk patients could profit from a tumor vaccination. To date, there is no effective systemic treatment for metastatic iridal melanoma.
Collapse
|
20
|
Wechselnde Augenfarbe bei okulärem Maskeradesyndrom. Ophthalmologe 2018; 115:517-520. [DOI: 10.1007/s00347-017-0575-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
21
|
Salvage proton beam therapy for recurrent iris melanoma: outcome and side effects. Graefes Arch Clin Exp Ophthalmol 2018; 256:1325-1332. [DOI: 10.1007/s00417-018-3929-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 01/28/2018] [Accepted: 02/02/2018] [Indexed: 11/25/2022] Open
|
22
|
Thariat J, Rahmi A, Salleron J, Mosci C, Butet B, Maschi C, Lanza F, Lanteri S, Baillif S, Herault J, Mathis T, Caujolle JP. Proton Beam Therapy for Iris Melanomas in 107 Patients. Ophthalmology 2017; 125:606-614. [PMID: 29128229 DOI: 10.1016/j.ophtha.2017.10.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/01/2017] [Accepted: 10/04/2017] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To report on the clinical characteristics and outcomes for patients with iris melanoma using proton therapy. DESIGN Retrospective study. PARTICIPANTS One hundred seven patients with iris melanoma from 3 regional ophthalmologic centers. METHODS A retrospective study was conducted for iris melanoma patients from 3 regional ophthalmologic centers referred to and treated at a single proton therapy facility between 1996 and 2015. MAIN OUTCOME MEASURES At each follow-up visit, examinations included measurement of best-corrected VA, slit-lamp, examination, indirect ophthalmoscopy, and ultrasound biomicroscopy. RESULTS With a median follow-up of 49.5 months, 5 of 107 patients experienced a local relapse within a median of 36.3 months. The cumulative incidence of relapse was 7.5% at 5 years. All 5 patients showed involvement of the iridocorneal angle (P = 0.056). Diffuse iris melanoma showed a higher risk of relapse (P = 0.044). Four patients showed out-of-field relapse and 1 showed angular relapse. Three patients were retreated with proton therapy, whereas 2 other patients, one with T1b disease and another with diffuse T3 disease, underwent secondary enucleation. None of the patients experienced metastases nor died of iris melanoma. Vision improved in 59.4% of patients (n = 60/101). However, cataracts occurred in 57.4% of the 54 patients (n = 31) without cataract or implant at diagnosis. Secondary glaucoma was reported in 7.6% of the patients (n = 8), uveitis in 4.7% (n = 5), and hyphema in 3.7% (n = 4). All but 5 cases of complications were mild, transient, and not sight limiting after treatment. Five cases of glaucoma, including 1 with uveitis, were severe and associated with visual deterioration. CONCLUSIONS Proton therapy showed efficacy and limited morbidity in iris melanomas.
Collapse
Affiliation(s)
- Juliette Thariat
- Department of Radiation Oncology, Cancer Centre Francois Baclesse, Normandie Universite-Unicaen, Caen, France; Department of Radiation Oncology, Cancer Centre Antoine Lacassagne, Nice, France.
| | - Ahmed Rahmi
- Department of Ophthalmology, Croix-Rousse University Hospital, University Claude Bernard Lyon 1, Lyon, France
| | - Julia Salleron
- Department of Biostatistics and Data Management, Institut de Cancerologie de Lorraine, Vandoeuvre-Les-Nancy, France
| | - Carlo Mosci
- Department of Ophthalmology, Ocular Oncology Center, E.O. Ospedali Galliera, Genoa, Italy
| | - Benjamin Butet
- Department of Ophthalmology, University Hospital Pasteur 2, Nice, France
| | - Celia Maschi
- Department of Ophthalmology, University Hospital Pasteur 2, Nice, France
| | - Francesco Lanza
- Department of Ophthalmology, Ocular Oncology Center, E.O. Ospedali Galliera, Genoa, Italy
| | - Sara Lanteri
- Department of Ophthalmology, University Hospital Pasteur 2, Nice, France
| | - Stephanie Baillif
- Department of Ophthalmology, University Hospital Pasteur 2, Nice, France
| | - Joel Herault
- Department of Radiation Oncology, Cancer Centre Antoine Lacassagne, Nice, France
| | - Thibaud Mathis
- Department of Ophthalmology, Croix-Rousse University Hospital, University Claude Bernard Lyon 1, Lyon, France
| | | |
Collapse
|
23
|
Fabian ID, Thaung C, AlHarby L, Sisley K, Mudhar HS, Doherty RE, Stacey AW, Arora AK, Cohen VML, Sagoo MS. Late Solitary Extraocular Recurrence From Previously Resected Iris Melanoma. Am J Ophthalmol 2017; 181:97-105. [PMID: 28673748 DOI: 10.1016/j.ajo.2017.06.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/21/2017] [Accepted: 06/23/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE To report on cases of late extraocular relapse of previously resected iris melanoma, without concurrent intraocular recurrence. DESIGN Retrospective case series. METHODS A retrospective chart review of 4 patients diagnosed with late subconjunctival relapse of previously resected iris melanoma. RESULTS Three female patients and 1 male patient underwent iris tumor resection and presented to our service with suspicious conjunctival lesions at a median of 22 years later (mean: 21 years). None showed intraocular relapse. Treatment of the conjunctival tumors included excisional biopsy (n = 4), followed by cryotherapy (n = 3) and/or brachytherapy (n = 3). In all cases, histopathology confirmed malignant melanoma, with no intraepithelial component or associated melanosis. Genetic sequencing (n = 3) showed wild-type BRAF and NRAS in all. GNA11 mutation was found in 1 case. On array-based comparative genomic hybridization (n = 3), gain of 6p was found in 2 cases and gain of 8 in 2. Overall, findings were strongly suggestive of a diagnosis of late extraocular relapse from previously resected iris melanoma. In a median of 2.5 years (mean: 7.7 years) from the subconjunctival relapse, no further episodes of intraocular/extraocular recurrence were recorded, and all patients were free from distant metastasis. CONCLUSIONS Patients undergoing iris melanoma resection are at risk of developing late solitary extraocular relapse even more than 30 years after surgery. In the absence of an intraocular component, diagnosis may be challenging, as tumors mimic a primary conjunctival lesion. Management by excisional biopsy followed by adjuvant therapy was successful, and histopathology and genetic analysis supported a diagnosis of extraocular uveal tumor spread rather than a primary conjunctival tumor.
Collapse
Affiliation(s)
- Ido Didi Fabian
- Ocular Oncology Service, Moorfields Eye Hospital, London, United Kingdom; Ocular Oncology Service, Goldschleger Eye Institute, Sheba Medical Center, Tel-Aviv University, Tel Aviv, Israel.
| | - Caroline Thaung
- Ocular Oncology Service, Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, London, United Kingdom
| | - Lamis AlHarby
- Ocular Oncology Service, Moorfields Eye Hospital, London, United Kingdom
| | - Karen Sisley
- Academic Unit of Ophthalmology & Orthoptics, Department of Oncology & Metabolism, The Medical School, The University of Sheffield, Sheffield, United Kingdom
| | - Hardeep S Mudhar
- National Specialist Ophthalmic Pathology Service, Department of Histopathology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Rachel E Doherty
- Academic Unit of Ophthalmology & Orthoptics, Department of Oncology & Metabolism, The Medical School, The University of Sheffield, Sheffield, United Kingdom
| | - Andrew W Stacey
- Ocular Oncology Service, Moorfields Eye Hospital, London, United Kingdom; Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Amit K Arora
- Ocular Oncology Service, Moorfields Eye Hospital, London, United Kingdom
| | - Victoria M L Cohen
- Ocular Oncology Service, Moorfields Eye Hospital, London, United Kingdom
| | - Mandeep S Sagoo
- Ocular Oncology Service, Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, London, United Kingdom
| |
Collapse
|
24
|
Cavusculu M, Yetik IS, Yeginer M. Fully automated blink detection for uveal melanoma radiotherapy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:628-631. [PMID: 29059951 DOI: 10.1109/embc.2017.8036903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Uveal melanoma is a widespread neoplasm in the eye that cause vision defects. The disease may result in loss of eye, even loss of life with a risk of metastasis to other tissues. There have been proposed various treatment methods to overcome the disease including enucleation and radiotherapy. Radiotherapy treatment is certainly preferable since it avoids the loss of eye. The treatment is applied with radioactive beam directed to the tumor, and thus the eye must be kept steady usually with local anesthesia. However, anesthesia has many health risks; therefore it is preferable to perform this operation without it. This paper presents an approach where a camera will be recording the eye and the radiotherapy will immediately be halted when the eye is closed to avoid unnecessary beams directed to healthy regions of the eye. System is based on the classification of the acquired image frames as "eye open" and "eye closed". The speed of the algorithm is aimed as close as possible to real time so that it can respond instantly to any change in present eye state. A total of 480 video frames, 120 frames for each open and closed eyes in bright and dark lighting conditions separately, were used for experimentation. Test results indicate that developed features are successful in terms of being very fast providing no classification error.
Collapse
|
25
|
Riechardt AI, Karle B, Cordini D, Heufelder J, Budach V, Joussen AM, Gollrad J. Proton therapy of iris melanoma with 50 CGE : Influence of target volume on clinical outcome. Strahlenther Onkol 2017. [PMID: 28631017 DOI: 10.1007/s00066-017-1166-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study was to evaluate local tumour control, incidence of radiation-induced glaucoma and associated interventions of sector-based and whole anterior segment proton beam therapy (PBT) for the treatment of iris melanoma. PATIENTS AND METHODS We retrospectively analysed the data of 77 patients with iris melanoma who underwent PBT applied as 50 CGE in four daily fractions. Of the patients, 47 received PBT with a circular-shaped collimator and 30 with a conformal sector-shaped target volume. Local control, eye preservation and secondary glaucoma were evaluated. RESULTS Median follow-up time was 54.9 months. Local tumour control was 100% in patients receiving whole anterior segment irradiation. Two patients developed pigment dispersion in the non-irradiated area after sector-based PBT and received whole anterior segment salvage PBT. The mean volume of ciliary body irradiated was 89.0% and 34.9% for whole anterior segment and lesion-based irradiation, respectively. At the end of follow-up, secondary glaucoma was found in 74.3% of the patients with whole anterior segment irradiation and in 19.2% with sector-based irradiation. Patients with sector-based PBT had a stable visual acuity of logMAR 0.1, while it declined from logMAR 0.1 to 0.4 after whole anterior segment irradiation. CONCLUSION We found a significant reduction in radiation-induced secondary glaucoma and glaucoma-associated surgical interventions and stable visual acuity after sector-based irradiation compared with whole anterior segment irradiation. Sector-based irradiation revealed a higher risk for local recurrence, but selected patients with well-circumscribed iris melanoma benefit from applying a lesion-based target volume when treated with sector-based PBT.
Collapse
Affiliation(s)
- Aline I Riechardt
- Department of Ophthalmology, Charité University of Medicine, Berlin, Germany
| | - Bettina Karle
- Department of Radiation Oncology, Helios Klinikum Emil-von-Behring, Berlin, Germany
| | - Dino Cordini
- Department of Ophthalmology, Charité University of Medicine, Berlin, Germany.,Berlin-Protonen, Helmholtz-Zentrum Berlin, Lise-Meitner-Campus, Berlin, Germany
| | - Jens Heufelder
- Department of Ophthalmology, Charité University of Medicine, Berlin, Germany.,Berlin-Protonen, Helmholtz-Zentrum Berlin, Lise-Meitner-Campus, Berlin, Germany
| | - Volker Budach
- Department of Radiation Oncology, Charité University of Medicine, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Antonia M Joussen
- Department of Ophthalmology, Charité University of Medicine, Berlin, Germany
| | - Johannes Gollrad
- Berlin-Protonen, Helmholtz-Zentrum Berlin, Lise-Meitner-Campus, Berlin, Germany. .,Department of Radiation Oncology, Charité University of Medicine, Hindenburgdamm 30, 12200, Berlin, Germany.
| |
Collapse
|
26
|
Agraval U, Sobti M, Russell HC, Lockington D, Ritchie D, Cauchi P, Kemp EG, Chadha V. Use of Ruthenium-106 Brachytherapy for Iris Melanoma: The Scottish Experience. Br J Ophthalmol 2017; 102:74-78. [PMID: 28600302 DOI: 10.1136/bjophthalmol-2017-310278] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/24/2017] [Accepted: 04/29/2017] [Indexed: 11/04/2022]
Abstract
PURPOSE To analyse long-term outcomes of ruthenium-106 (106Ru) plaque brachytherapy for the treatment of iris melanoma. METHODS We retrospectively reviewed medical records of 19 consecutive patients with pure iris melanoma treated with 106Ru plaque brachytherapy between 1998 and 2016 at the Scottish Ophthalmic Oncology Service, Glasgow. The iris melanoma was treated with a ruthenium plaque placed on the corneal surface to deliver a surface dose of 555 Gy. We analysed vision preservation, local tumour control, radiation-related complications, eye retention rates, symptomatic metastasis and melanoma-related mortality. RESULTS The mean largest basal diameter of the lesions was 3.50±1.42 mm (range 1.6-6.5 mm), and the mean maximum height was 1.47±0.65 mm (range 0.7-2.8 mm). The tumour control and eye retention were 100% at a mean follow-up of 62 months (range 6-195 months). A 62% reduction in tumour height was observed on ultrasonography. Complications included cataract (68%), dry eye (47%), uveitis (37%) and scleral thinning (5%). At the final follow-up visit, the mean loss of Snellen visual acuity was 1.11±2.90 lines and vision of 6/9 or better was maintained in 53% of patients. None of the patients had evidence of symptomatic metastasis (non-imaged) or melanoma-related mortality. CONCLUSIONS 106Ru plaque treatment for iris melanoma was highly effective a high tumour control, no tumour recurrences and a relatively a low complication rate.
Collapse
Affiliation(s)
- Umiya Agraval
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| | - Manvi Sobti
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| | - Heather C Russell
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| | - David Lockington
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| | - Diana Ritchie
- Oncology, Beatson West of Scotland Cancer Center, Glasgow, UK
| | - Paul Cauchi
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| | - Ewan G Kemp
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| | - Vikas Chadha
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| |
Collapse
|
27
|
Popovic M, Ahmed IIK, DiGiovanni J, Shields CL. Radiotherapeutic and surgical management of iris melanoma: A review. Surv Ophthalmol 2017; 62:302-311. [DOI: 10.1016/j.survophthal.2016.12.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 12/16/2016] [Accepted: 12/23/2016] [Indexed: 10/20/2022]
|
28
|
Singh AD. Small incision guarded hydroaspiration of iris lesions. Br J Ophthalmol 2017; 101:1570-1575. [DOI: 10.1136/bjophthalmol-2016-310093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/09/2017] [Accepted: 02/18/2017] [Indexed: 11/03/2022]
|
29
|
Results in Combined Cataract Surgery With Prosthetic Iris Implantation in Patients With Previous Iridocyclectomy for Iris Melanoma. Am J Ophthalmol 2017; 175:45-51. [PMID: 27939562 DOI: 10.1016/j.ajo.2016.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/24/2016] [Accepted: 11/29/2016] [Indexed: 02/03/2023]
Abstract
PURPOSE To present visual and functional results following implantation of iris prosthesis combined with cataract surgery in eyes with previous iridocyclectomy for iris melanoma or presumed iris melanoma. DESIGN Retrospective noncomparative case series. METHODS Sixteen patients (16 eyes) with iris defects after iridocyclectomy for iris melanoma in 15 cases and iris adenoma in 1 case underwent prosthetic iris device implantation surgery. Prosthetic iris implantation was combined with phacoemulsification and intraocular lens (IOL) implantation. The visual acuity, subjective glare and photophobia reduction, anatomic outcome, and complications were reviewed. RESULTS Best-corrected visual acuity was improved in 13 eyes (81.25%), remained stable in 2 eyes (12.25%), and decreased in 1 eye (6.25%). Photophobia and glare improved in every case except for 1 (93.75%). Notably, after surgery 12 patients (75.00%) reported no photophobia and 10 patients (62.50%) reported no glare. The median postoperative follow-up was 29.5 months, with a minimum of 5 months and a maximum of 189 months. All iris devices were in the correct position, and all eyes achieved the desired anatomic result. The IOL optic edges were covered in all areas by either residual iris or opaque portions of a prosthetic iris device. CONCLUSIONS In patients who have undergone previous iridocyclectomy for presumed iris melanoma, combined cataract surgery and iris prosthesis placement, with or without iris reconstruction, can lead to visual improvement as well as reduction of both glare and photophobia.
Collapse
|
30
|
Nevoid iris melanoma, case report. ACTA ACUST UNITED AC 2016; 92:347-350. [PMID: 27262610 DOI: 10.1016/j.oftal.2016.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 04/27/2016] [Accepted: 04/28/2016] [Indexed: 11/21/2022]
Abstract
CASE REPORT The case is presented of a patient with diagnosis of iris nevus in the left eye in youth with a poor follow-up, who referred a decreased visual acuity in that eye. A hyphaema and a 3×4×3mm nodule with irregular pigmentation was observed. Excision of the tumour and histological analysis confirmed the suspicion of iris melanoma in stage Ia. DISCUSSION Despite the low grade malignancy of iris melanoma and the low frequency of transformation of iris nevus into melanoma, a follow-up is required for its early diagnosis and treatment.
Collapse
|
31
|
UNTREATED IRIS MELANOMA COMPLICATED BY HYPHEMA AND UNCONTROLLED GLAUCOMA RESPONSIVE TO IODINE-125 BRACHYTHERAPY. Retin Cases Brief Rep 2015; 10:44-7. [PMID: 26383516 DOI: 10.1097/icb.0000000000000171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe a case of iris melanoma for which a patient refused treatment for 15 years, and the complications that resulted. METHODS Single case report. RESULTS A 52-year-old white man was evaluated for a suspicious pigmented lesion of the left iris. He was followed closely with serial examinations and ultrasound biomicroscopy, and he refused therapy when the lesion showed growth 15 years after presentation. The patient subsequently developed recurrent hyphema, intraocular pressure up to 55 mmHg, and glaucomatous optic neuropathy. He eventually underwent iodine-125 brachytherapy resulting in tumor regression and improvement of intraocular pressure. CONCLUSION Untreated iris melanoma can develop complications such as recurrent hyphema and glaucoma with irreversible optic nerve damage. Treatment of slow-growing iris melanoma must be considered to prevent complications.
Collapse
|
32
|
Kottschade LA, Grotz TE, Dronca RS, Salomao DR, Pulido JS, Wasif N, Jakub JW, Bagaria SP, Kumar R, Kaur JS, Morita SY, Moran SL, Nguyen JT, Nguyen EC, Hand JL, Erickson LA, Brewer JD, Baum CL, Miller RC, Swanson DL, Lowe V, Markovic SN. Rare presentations of primary melanoma and special populations: a systematic review. Am J Clin Oncol 2014; 37:635-41. [PMID: 23563206 PMCID: PMC4349521 DOI: 10.1097/coc.0b013e3182868e82] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
A subset of patients with melanoma present in rare and unique clinical circumstances requiring specific considerations with respect to diagnostic and therapeutic interventions. Herein, we present our review of patients with: (1) primary mucosal melanoma of the head and neck, gastrointestinal, and genitourinary tracts; (2) primary melanoma of the eye; (3) desmoplastic melanoma; (4) subungual melanoma; (5) melanoma in special populations: children, nonwhites, as well as a discussion of familial melanoma.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Riten Kumar
- Department of Pediatric Hematology/Oncology-Hospital for Sick Children, Toronto
| | | | - Shane Y. Morita
- The Queen’s Medical Center/Queen’s Cancer Center-University of Hawaii/John A Burns School of Medicine
| | | | | | | | - Jennifer L. Hand
- Department of Dermatology-Mayo Clinic
- Department of Pediatrics-Mayo Clinic
- Department of Medical Genetics-Mayo Clinic
| | | | | | | | | | | | - Val Lowe
- Department of Radiology-Mayo Clinic
| | - Svetomir N. Markovic
- Department of Oncology- Mayo Clinic
- Department of Hematology-Mayo Clinic
- Department of Immunology-Mayo Clinic
| |
Collapse
|
33
|
Proton beam therapy for presumed and confirmed iris melanomas: a review of 36 cases. Graefes Arch Clin Exp Ophthalmol 2014; 252:1515-21. [PMID: 25038910 DOI: 10.1007/s00417-014-2735-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 06/23/2014] [Accepted: 07/02/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND To report the clinical features and outcomes of iris melanomas treated by proton beam therapy. MATERIALS AND METHODS A retrospective study was conducted at the Croix-Rousse University Hospital of Lyon, Department of Ophthalmology, in 36 patients treated by proton beam therapy for presumed (n = 29) and confirmed (n = 7) iris melanomas between July 1997 and October 2010. Ciliary body melanomas with iris involvement were excluded. The patients' mean age was 54.4 years (range, 22-82 years). The average tumor diameter was 3.8 mm (range, 2.5-8.0). The iridocorneal angle was invaded by the tumor in 47% of cases (n = 17), the ciliary body in 17% of cases (n = 6), and the sclera in 3% (n = 1). Raised intraocular pressure was present before treatment in 11.1 % of cases (n = 4). Tumor biopsy was performed in 19% of cases (n = 7). Four patients had undergone an initial incomplete surgical excision of tumor before radiotherapy. Surgical preparation of the eye with tantalum ring positioning had been performed in all cases 3-4 weeks before irradiation. The prescribed dose was 60 Cobalt Gray Equivalent (CGE) of proton beam radiotherapy delivered in four fractions on four consecutive days. RESULTS The median follow-up was 50 months (mean 60.5, range 15-136). One patient (2.7%) was lost to follow-up. None of the patients showed tumor progression, local recurrence, or metastasis. None of the patients required secondary enucleation. Cataract was developed in 62% of patients, glaucoma in two cases (6%) after irradiation, and hyphema with the aggravation of pre-existing glaucoma in one patient. No patients developed neovascular glaucoma. CONCLUSIONS Proton beam therapy appears to be the treatment of choice for the conservative treatment of iris melanomas with excellent tumor control and an acceptable rate of complications. Longer follow-up studies on a larger series is necessary to consolidate these results.
Collapse
|
34
|
Sandinha MT, Kacperek A, Errington RD, Coupland SE, Damato B. Recurrence of iris melanoma after proton beam therapy. Br J Ophthalmol 2014; 98:484-7. [DOI: 10.1136/bjophthalmol-2013-303321] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
35
|
Jovanovic P, Mihajlovic M, Djordjevic-Jocic J, Vlajkovic S, Cekic S, Stefanovic V. Ocular melanoma: an overview of the current status. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2013; 6:1230-44. [PMID: 23826405 PMCID: PMC3693189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 05/23/2013] [Indexed: 06/02/2023]
Abstract
Ocular melanoma is the second most common type of melanoma after cutaneous and the most common primary intraocular malignant tumor in adults. Large majority of ocular melanomas originate from uvea, while conjunctival melanomas are far less frequent. Incidence of uveal melanoma has remained stable over last three decades. Diagnosis is in most cases established by clinical examination with great accuracy. Local treatment of uveal melanoma has improved, with increased use of conservative methods and preservation of the eye, but survival rates have remained unchanged. Recent advances in cytogenetics and genetics enhanced prognostication and enabled to determine tumors with high metastatic potential. However, due to lack of effective systemic therapy, prognosis of patients with metastasis remains poor and metastatic disease remains the leading cause of death among patients with uveal melanoma. Conjunctival melanoma is rare, but its incidence is increasing. It mostly occurs among white adults. In majority of cases it originates from preceding primary acquired melanosis. Current standard treatment for conjunctival melanoma is wide local excision with adjuvant therapy, including brachytherapy, cryotherapy and topical application of chemotherapeutic agent. Rarity of this tumor limits conduction of controlled trials to define the best treatment modality. As well as for uveal melanoma, prognosis of patients with metastasis is poor because there is no effective systemic therapy. Better understanding of underlying genetic and molecular abnormalities implicated in development and progression of ocular melanomas provides a great opportunity for development of targeted therapy, which will hopefully improve prognosis of patients with metastatic disease.
Collapse
Affiliation(s)
- Predrag Jovanovic
- Clinic of Ophthalmology, Faculty of Medicine, University of NisNis, Serbia
| | - Marija Mihajlovic
- Department of Clinical Research, Faculty of Medicine, University of NisNis, Serbia
| | | | - Slobodan Vlajkovic
- Department of Anatomy, Faculty of Medicine, University of NisNis, Serbia
| | - Sonja Cekic
- Clinic of Ophthalmology, Faculty of Medicine, University of NisNis, Serbia
| | - Vladisav Stefanovic
- Department of Clinical Research, Faculty of Medicine, University of NisNis, Serbia
| |
Collapse
|
36
|
Klauber S, Jensen PK, Prause JU, Kessing SV. Surgical treatment of iris and ciliary body melanoma: follow-up of a 25-year series of patients. Acta Ophthalmol 2012; 90:122-6. [PMID: 20456258 DOI: 10.1111/j.1755-3768.2010.01889.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate outcome of surgical resection of iris and irido-ciliary melanomas. METHOD Retrospective analysis of all cases treated in Denmark 1975-1999 with clinical follow-up in 2002 and death certificate analysis in 2008. A quality of life questionnaire was completed at follow-up. RESULTS A total of 53 patients were identified. Of these, 47 were examined at follow-up. Median observation time was 7.15 years (range 0.3-27.4 years). Five patients had died of nonmelanoma causes, and one could not be reached because of immigration. None of the patient had melanoma metastases, and none had died of melanoma-related causes. Only one patient had a local recurrence, which was successfully treated by cryotherapy. The quality of life-related questions demonstrated that most patients (40) suffered from photophobia, and eight patients had changed their driving habits, not driving at night time. However, none had changed job as a consequence of the surgical treatment. Only two patients were emotionally affected by the diagnosis of iris melanoma. CONCLUSION Resection of small iris and irido-ciliary melanomas is a safe and efficient procedure, provided that strict diagnostic and surgical procedures are followed and the preoperative intraocular pressure is normal.
Collapse
Affiliation(s)
- Stefan Klauber
- Department of Ophthalmology, State University Hospital, Copenhagen, Denmark
| | | | | | | |
Collapse
|
37
|
Rennie IG. Don't it make my blue eyes brown: heterochromia and other abnormalities of the iris. Eye (Lond) 2012; 26:29-50. [PMID: 21979861 PMCID: PMC3259577 DOI: 10.1038/eye.2011.228] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 07/19/2011] [Indexed: 12/26/2022] Open
Abstract
Eye colour is one of the most important characteristics in determining facial appearance. In this paper I shall discuss the anatomy and genetics of normal eye colour, together with a wide and diverse range of conditions that may produce an alteration in normal iris pigmentation or form.
Collapse
Affiliation(s)
- I G Rennie
- Academic Unit of Ophthalmology & Orthoptics, University of Sheffield, Sheffield, UK.
| |
Collapse
|
38
|
Shah SU, Shields CL, Bianciotto C, Emrich J, Komarnicky L, Shields JA. Plaque radiotherapy for residual or recurrent iris melanoma after surgical resection in 32 cases. Ophthalmology 2011; 119:838-842.e2. [PMID: 22133794 DOI: 10.1016/j.ophtha.2011.09.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 08/14/2011] [Accepted: 09/19/2011] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate plaque radiotherapy for management of residual or recurrent iris melanoma after surgical resection. DESIGN Retrospective, nonrandomized interventional case series. PARTICIPANTS We included 32 patients with residual or recurrent iris melanoma after surgical resection. INTERVENTION Custom designed iodine-125 plaque radiotherapy. MAIN OUTCOME MEASURES Tumor control, recurrence, poor visual acuity, enucleation, metastasis, and radiation complications. RESULTS There were 32 eyes with residual (n = 12) or recurrent (n = 20) iris melanoma after surgical resection that were treated with iodine-125 plaque radiotherapy. The residual melanoma was evident clinically in 3 cases and histopathologically in 9; plaque radiotherapy was delivered at a mean interval of 2 months after resection. For the recurrent cases, the mean interval from initial tumor resection to detection of recurrence was 58 months, at which time plaque radiotherapy was applied. For all cases, the mean tumor basal diameter was 6 mm (range, 1-13) and thickness was 2 mm (range, 0.8-4.0) at the time of radiotherapy. Anterior chamber seeding was present in 26 (81%) eyes and glaucoma in 11 (34%) eyes. Visual acuity at presentation was good (20/20-20/50) in 27 (84%), intermediate (20/60-20/150) in 3 (9%), and poor (≤20/200) in 2 eyes (6%). At 6 years after plaque radiotherapy, outcomes included complete tumor control in 87%, poor visual acuity in 9%, enucleation in 13% (for reasons of tumor recurrence [n = 3] and severe glaucoma [n = 1]), and metastasis in 3%. At 6 years, radiation complications included corneal epitheliopathy in 6%, scleral necrosis in 3%, cataract in 53%, elevated intraocular pressure (from tumor or radiotherapy) in 19%, and macular edema in 6%. CONCLUSIONS Iodine-125 plaque radiotherapy is effective in the management of residual or recurrent iris melanoma after surgical resection, providing tumor control in 87% of patients at 6 years and avoiding enucleation in most cases.
Collapse
Affiliation(s)
- Sanket U Shah
- Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | |
Collapse
|
39
|
Petousis V, Finger PT, Milman T. Anterior segment tumor biopsy using an aspiration cutter technique: clinical experience. Am J Ophthalmol 2011; 152:771-5.e1. [PMID: 21794840 DOI: 10.1016/j.ajo.2011.04.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 04/26/2011] [Accepted: 04/29/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the results and complications of an aspiration cutter-assisted anterior segment tumor biopsy performed under viscoelastic. DESIGN Retrospective, consecutive, interventional case series. METHODS Fifty-five patients with anterior segment tumors underwent aspiration cutter-assisted biopsy at a single center. Fifty-six biopsies were performed, because 1 eye underwent biopsy twice. Indications for biopsy included: suspected anterior segment malignancy, patient's desire for pathologic confirmation before treatment, atypical tumor, and genetic tumor analysis. The main evaluated outcomes were the perioperative visual acuity, the biopsy technique, and related complications. RESULTS The initial sample comprised 55 consecutively biopsied patients, from which a minimum 1-month follow-up existed for 52 biopsy samples. The median total follow-up was 30.4 months (range, 1 to 190 months). The mean initial visual acuity was 20/50 before and 20/50 1 month after biopsy. No patient lost vision. Most cases were suspected iris melanoma (n = 39/56; 69.6%), followed by suspicious iris nevi (n = 4/56; 7.1%) and melanocytoma (n = 4/56; 7.1%). Seven (n = 7/52; 13.4%) wounds required a single 10-0 nylon suture to achieve negative Seidel test results at the corneal entry site. Postoperative surgical findings included transiently increased intraocular pressure (n = 6/52; 11.5%), 1 hyphema, 1 flare, and 1 persistent pupillary defect. All but the pupillary defect resolved within 4 weeks of the biopsy procedure. There were no secondary infections or cataracts. CONCLUSIONS This study suggests that small-incision, aspiration cutter-assisted anterior segment biopsy seems to be a safe and effective procedure. No short- or long-term complications that would prevent its use were noted.
Collapse
|
40
|
Tsimpida M, Hungerford J, Arora A, Cohen V. Plaque radiotherapy treatment with ruthenium-106 for iris malignant melanoma. Eye (Lond) 2011; 25:1607-11. [PMID: 21941358 DOI: 10.1038/eye.2011.222] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To report the results of ruthenium-106 plaque radiotherapy for iris malignant melanoma. METHODS A retrospective study of 15 patients with pure iris melanoma treated with ruthenium-106 plaque radiotherapy from June 1998 to June 2006. The main outcome measures were tumour control and ocular complications. RESULTS Of the 15 patients, 8 had biopsy-proven melanoma (6 incisional and 2 excisional biopsies). In the remaining seven patients enlargement of the lesion was documented. The median follow-up was 96 months (ranging from 14 months to 12 years). Common radiation-related complications included cataract in 9 (60%) patients, dry eyes in 3 (20%) patients and elevated intraocular pressure in 4 (27%) patients. Vision was preserved in 80% of patients. Local tumour control was obtained in all patients. CONCLUSIONS Ruthenium-106 plaque radiotherapy is an effective treatment for primary malignant iris melanoma, resulting in excellent local control with preservation of vision. Main complications included cataract, dry eyes, and glaucoma.
Collapse
Affiliation(s)
- M Tsimpida
- Department of Ophthalmology, St Bartholomew's Hospital and Moorfields Eye Hospital, London, UK.
| | | | | | | |
Collapse
|
41
|
Hood CT, Schoenfield LR, Torres V, Singh AD. Iris Melanoma. Ophthalmology 2011; 118:221-2. [DOI: 10.1016/j.ophtha.2010.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 09/08/2010] [Indexed: 10/18/2022] Open
|
42
|
Management of iris melanomas with 125Iodine plaque radiotherapy. Am J Ophthalmol 2010; 149:70-6. [PMID: 19892312 DOI: 10.1016/j.ajo.2009.08.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 08/05/2009] [Accepted: 08/06/2009] [Indexed: 11/22/2022]
Abstract
PURPOSE To report the experience of the Princess Margaret Hospital/University Health Network with the treatment of iris melanoma (IM) with (125)Iodine plaque brachytherapy. DESIGN Retrospective noncomparative case series. METHODS All cases of IM submitted to (125)Iodine plaque radiotherapy were included. Patients' demographic, clinical, management, and follow-up data were reviewed. Outcome measures included rates of tumor control, eye preservation, systemic metastases, and brachytherapy-related complications. RESULTS Fourteen IMs were included in the study. All patients had blue/green irises. Mean largest basal dimension and thickness were 7.1 +/- 2.1 mm (range, 4.0 to 11.5 mm) and 2.2 +/- 0.8 mm (range, 1.0 to 3.5 mm), respectively. Ten patients (71%) had seeding and 2 (14%) had glaucoma at presentation. Median follow-up was 26.6 +/- 19.5 months (range, 6 to 72 months). Tumor control was achieved in 100% of the cases and no eye was enucleated because of radiation-induced complications. At last visit, all patients were alive and free of metastasis. Final visual acuity was the same as or better than before treatment in 9 patients (75%). Cataract was the most common complication (8; 75%), followed by persistent glaucoma (2; 17%) and anterior uveitis (1; 8%). No other significant complication was seen during the follow-up period. CONCLUSIONS Plaque radiotherapy is a safe and effective conservative treatment option for IM, although cataract is a common, yet treatable, complication. This treatment scheme circumvents an intraocular procedure and may avoid the dissemination of malignant cells, and provides a margin of safety in the treatment of clinically undetectable disease.
Collapse
|
43
|
Canovas D, Rennie IG, Nichols CE, Sisley K. Local environmental influences on uveal melanoma: vitreous humor promotes uveal melanoma invasion, whereas the aqueous can be inhibitory. Cancer 2008; 112:1787-94. [PMID: 18300240 DOI: 10.1002/cncr.23358] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Uveal melanomas of the choroid and ciliary body are aggressive tumors causing the death of approximately 50% of patients. In contrast, iris melanomas only infrequently metastasize; why these differences exist is not known. The local environment can regulate cancer growth and development, and it is probable the aqueous and vitreous humors have an important role in regulating uveal melanoma behavior. METHODS To explore this possibility cultures of uveal melanoma were exposed to aqueous and vitreous and the effects investigated using invasion and proliferation assays. ChemiArrays (Chemicon International, Temecula, Calif) were performed to determine which regulatory factors might influence the process. RESULTS The vitreous universally promoted uveal melanoma invasion, whereas the aqueous mainly had no effect or was inhibitory. Tumor location, and the baseline invasion of the melanoma, affected the ability of aqueous and vitreous from different patients to regulate invasive behavior. Proliferation was not significantly altered as a result of exposure to the aqueous or vitreous. The ability of the humors to regulate uveal melanomas may involve TIMP-2, TIMP-3, and TGF-beta2, as high expression was found by ChemiArray analysis and there were differences in the levels of the regulators in the aqueous compared with the vitreous. CONCLUSIONS The findings suggest that in situ uveal melanoma development reflects an interaction between the tumor and the environment of the eye. Exposure to the aqueous would therefore contribute to the benign nature of iris melanomas, whereas potential interaction with the vitreous appears to promote the aggressive behavior of posterior uveal melanomas.
Collapse
Affiliation(s)
- David Canovas
- Academic Unit of Ophthalmology and Orthoptics, Section of Oncology, School of Medicine and Biomedical Sciences, University of Sheffield, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | | | | | | |
Collapse
|
44
|
Abstract
The iris is the least common site of primary uveal melanoma. The prognosis of iris melanoma is better than that of melanoma of the ciliary body and choroid, but the reason for this difference is unclear. One possible explanation is that iris melanoma is smaller than its posterior segment counterparts at the time of diagnosis. Most iris melanomas are spindle cell types, according to a modified Callender classification system. There is evidence that the proliferation of melanocytes of the anterior iris surface (iris plaque) and diffuse stromal invasion may be risk factors for local recurrence and metastasis, respectively.
Collapse
Affiliation(s)
- Evita Henderson
- Department of Pathology, Veterans Administration Hospital, Tampa, USA
| | | |
Collapse
|
45
|
Skalicky SE, Giblin M, Conway RM. Diffuse iris melanoma: Report of a case with review of the literature. Clin Ophthalmol 2007; 1:339-42. [PMID: 19668492 PMCID: PMC2701136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Diffuse iris melanoma is an uncommon variant of anterior uveal melanoma. It is characterized by heterochromia and unilateral glaucoma secondary to angle invasion, and can be difficult to diagnose. We present a patient who had been managed for left-sided raised intraocular pressure with latanoprost eye drops for 12-months and pigmentary changes were subsequently noted. On referral to the Ocular Oncology Unit, Sydney, iris melanoma was suspected and confirmed on iridectomy, and the eye was eventually enucleated.
Collapse
Affiliation(s)
| | | | - R Max Conway
- Correspondence: R Max Conway, Sydney Ocular Oncology Unit, c/- Save Sight Institute, GPO Box 4337, Sydney, NSW 2001, Australia, Tel +61 2 9382 7300, Fax +61 2 9382 7318, Email
| |
Collapse
|
46
|
Markovic SN, Erickson LA, Rao RD, Weenig RH, Pockaj BA, Bardia A, Vachon CM, Schild SE, McWilliams RR, Hand JL, Laman SD, Kottschade LA, Maples WJ, Pittelkow MR, Pulido JS, Cameron JD, Creagan ET. Malignant melanoma in the 21st century, part 2: staging, prognosis, and treatment. Mayo Clin Proc 2007; 82:490-513. [PMID: 17418079 DOI: 10.4065/82.4.490] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Critical to the clinical management of a patient with malignant melanoma is an understanding of its natural history. As with most malignant disorders, prognosis is highly dependent on the clinical stage (extent of tumor burden) at the time of diagnosis. The patient's clinical stage at diagnosis dictates selection of therapy. We review the state of the art in melanoma staging, prognosis, and therapy. Substantial progress has been made in this regard during the past 2 decades. This progress is primarily reflected in the development of sentinel lymph node biopsies as a means of reducing the morbidity associated with regional lymph node dissection, increased understanding of the role of neoangiogenesis in the natural history of melanoma and its potential as a treatment target, and emergence of innovative multimodal therapeutic strategies, resulting in significant objective response rates in a disease commonly believed to be drug resistant. Although much work remains to be done to improve the survival of patients with melanoma, clinically meaningful results seem within reach.
Collapse
Affiliation(s)
- Svetomir N Markovic
- Division of Hematology, College of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Lumbroso-Le Rouic L, Delacroix S, Dendale R, Levy-Gabriel C, Feuvret L, Noel G, Plancher C, Nauraye C, Garcia P, Calugaru V, Asselain B, Desjardins L. Proton beam therapy for iris melanomas. Eye (Lond) 2006; 20:1300-5. [PMID: 16294207 DOI: 10.1038/sj.eye.6702102] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
AIMS To describe the results in terms of local control, eye preservation and systemic evolution of iris melanomas treated by proton beam irradiation. METHODS Retrospective review of the charts of patients with iris melanoma treated by proton beam therapy between April 1998 and September 2002. Ciliary body melanomas with iris involvement or tumours with extrascleral invasion were excluded. Treatment consisted of 60 Gy of proton beam irradiation delivered in four fractions to the tumour volume. RESULTS A total of 21 patients were treated, median follow-up of 33 months (8-72 months). 15 patients presented a lesion with documented growth. The median clinical diameter was 5 mm (2-8 mm), the median ultrasound diameter 4.8 mm (2-7.7 mm) The patients were 6% T1, 57.1% T2, and 14.3% T3 all N0M0. The iridocorneal angle was invaded by the tumour in 71.4% of patients. At the end of follow-up, all patients were alive with no proven metastatic disease except one patient with suspicious liver lesions. None of the patients showed tumour progression or ocular relapse. The tumour response at 2 years was a flat lesion for 6.3% of cases, partial regression in 75% and stable in 18.8%. None of the patients required secondary enucleation. The main complication was cataract (45% within 24 months of treatment). Raised intraocular pressure was observed in 15% of patients but no neovascular glaucoma. CONCLUSIONS Proton beam therapy shows potential utility for selected cases of localised iris melanomas allowing excellent local tumour control and eye preservation. Further follow-up on larger series is needed to confirm these results.
Collapse
Affiliation(s)
- L Lumbroso-Le Rouic
- Department of ophthalmology, Institut Curie, Paris, France. livia.lumbroso@ curie.net
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Garcia-Arumi J, Montolio Gil M, Morral Palau M, Segura Garcia A. Sympathetic ophthalmia after surgical resection of iridociliary melanoma. A case report. Graefes Arch Clin Exp Ophthalmol 2006; 244:1353-6. [PMID: 16523295 DOI: 10.1007/s00417-006-0299-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2005] [Revised: 01/07/2006] [Accepted: 02/09/2006] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND We report a case of sympathetic ophthalmia with systemic findings following resection of a malignant melanoma of the iris and ciliary body, and describe the treatment and clinical outcome. METHODS A 49-year-old man underwent sector iridocyclectomy of a malignant iridociliary melanoma of the right eye. Five weeks later, he was diagnosed with sympathetic ophthalmia. Snellen's best-corrected visual acuity, fluorescein angiography, electroretinography, cerebrospinal fluid analysis and audiometry were performed. High-dose systemic steroid and immunosuppressive (cyclosporine and azathioprine) therapy was prescribed. Two months later chorioretinitis and macular edema persisted, and intravitreous triamcinolone was injected into the right eye. RESULTS Five weeks after resection of an iridociliary melanoma, our patient had reported acute bilateral vision loss. Visual acuity was hand motion in both eyes. Examination showed bilateral granulomatous uveitis, diffuse choroiditis with Dalen-Fuchs nodules, papillitis and vitritis. On fluorescein angiography multiple hyperfluorescent dots, which coalesced in areas of exudative retinal detachment, were evident. The patient presented meningismus with pleocytosis on cerebrospinal fluid analysis, and sensorineural deafness. Sympathetic ophthalmia was diagnosed. High-dose intravenous steroids followed by oral prednisone at a tapering dose and immunosuppressive agents (cyclosporine and azathioprine), topical steroids in both eyes and intravitreal steroids in the right eye were administered. Phacoemulsification and intraocular lens implantation were performed to treat a dense cataract of the right eye. After 24 months of follow-up, best-corrected visual acuity was 20/200 in the right eye and 20/25 in the left; no signs of intraocular inflammation were observed and neurological signs had resolved. Low maintenance doses of systemic steroids and immunosuppressive agents were administered up to month 18 of follow-up to avoid recurrence. CONCLUSIONS Sympathetic ophthalmia is a rare, but severe disease that can occur after resection of iridociliary melanoma. High-dose steroid therapy and supplementation with immunosuppressive agents early in the course of the disease was effective in resolving the condition.
Collapse
Affiliation(s)
- Jose Garcia-Arumi
- Insituto de Microcirugia Ocular, Ophthalmology, Munner 10, 08022, Barcelona, Spain.
| | | | | | | |
Collapse
|
49
|
Abstract
AIM To report results of proton beam therapy for iris melanoma. METHODS A retrospective case series of 15 patients with nonresectable iris melanomas treated with proton beam therapy between August 1998 and August 2004. The main outcome measures were (1) local tumour control, (2) complications, and (3) eye retention. RESULTS Of the 15 cases, 11 patients showed documented growth (including two cases of local recurrence following iridocyclectomy) while a further three cases were biopsy-proven melanoma. One patient presented with a newly acquired vascular nodule of the iris associated with angle seeding and glaucoma. Tumour control at mean follow-up of 34 months was 93% (14 of 15 eyes). Common complications included glaucoma in 53% (five patients had glaucoma prior to irradiation), dry eye (27%) and cataract in three patients (20%). Eye retention was possible in 80% (12 cases). CONCLUSION Proton beam therapy is an effective treatment for cases of nonresectable iris melanoma. The major complications are cataract and glaucoma.
Collapse
Affiliation(s)
- P Rundle
- Ocular Oncology Clinic, Royal Hallamshire Hospital, Sheffield, UK.
| | | | | |
Collapse
|
50
|
Abstract
Iris melanoma is a rare ocular tumour, which can be detected early in its development. This tumour is almost always unilateral and arises usually from a pre-existing naevus. Failure to detect it may be associated with morbid ocular and systemic complications, yet there are successful therapies to treat this condition, if detected early. The patient presented to the eye clinic with symptoms of occasional, brief loss of vision in his left eye for a few weeks prior to his visit. Slit-lamp examination revealed a mass on the inferior part of the iris of the left eye. Intra-ocular pressure measurements were RE 15 mmHg and LE 38 mmHg. It was found that a tumour had spread throughout the iris stroma and invaded the anterior chamber angle. Although enucleation would have been the treatment of choice in the past, the trend today in the treatment of a growing, large circumscribed iris tumour is to excise it. It was successfully excised by irido-cyclo-trabeculectomy.
Collapse
Affiliation(s)
- Michel Millodot
- Department of Optometry, Hadassah College of Technology, Jerusalem, Israel.
| | | | | |
Collapse
|