Posters

Melanomalytic glaucoma: benefit of the doubt

Poster Details

First Author: A. Muscalu ROMANIA

Co Author(s):    M. Pavel   T. Stefanache   A. Cantemir   A. Pantalon   D. Chiselita        

Abstract Details

Purpose:

We present a case of a 58 year-old male patient referred to a tertiary ophthalmology center for an unilateral long standing uveal ectropion whose only complaint was this abnormal iris appearance.

Setting:

All the investigations were performed in “St. Spiridon” University Hospital (Eye Clinic), Iasy, Romania.

Methods:

At presentation patient’s eye was quiet, 20/20 visual acuity,high intraocular pressure (54 mmHg). Anterior segment examination: uveal ectropion, moderate pigment dispersion, minimal pupillary distortion and sectorial bumpy iris appearance confined to the 5 o’clock meridian. Gonioscopy revealed pigmented iris tumor (2/3 mm) extended to anterior chamber angle, with trabecular meshwork invasion. A thin whitish membrane was visible adjacent to the tumor borders over the trabeculum. Further investigations (ocular ultrasound, ultrasound biomicroscopy, cerebral CT) correlated with clinical examinations raised high suspicion for malignant metastatic irido-ciliary tumor and secondary glaucoma due to migrated malignant cells obstructing the anterior chamber angle.

Results:

After presenting the surgical options to the patient, according to his decision, age, slow tumor growth rate and thorough cerebral MRI scan that oriented the structure of the intracranial mass to a meningioma structure, we performed conservative surgery (iridocyclectomy). Postoperatory status was good,VA increased in 72 hours from counting fingers/20 cm to 20/60. IOP remained stable around 19 mmHg. Patient had clear cornea, no hyphema, mid-anterior iris defect between 3 and 7 o’clock meridians, clear lens and no vitreous hemorrhage. Classic histology was inconclusive for a clear malignancy diagnosis, Further mmunohistochemical analysis was proved melanocytic iris nevus with fusiform cells

Conclusions:

This patient fortunate case demonstrated that the clinical suspicion might be misleading sometimes and thorough investigations were required for a certain and complete picture. Yet long term monitoring is required in this case as the situation remains still in a grey zone.

Financial Disclosure:

NONE