Anterior segment swept-source optical coherence tomography and ultrasound biomicroscopy in iris and ciliary body lesions.

OBJECTIVES: Differentiation of iris and ciliary body lesions as benign or malignant and cystic or solid is important. The aim of this study was to compare anterior segment swept-source optical coherence tomography (AS SS-OCT) and ultrasound biomicroscopy (UBM) findings in iris and ciliary body tumors. RESEARCH DESIGN AND METHODS: Forty-two eyes of 38 cases with iris and ciliary body tumors imaged with UBM and AS SS-OCT between September 2018 and September 2023 were evaluated retrospectively. RESULTS: Of 42 eyes, 14 had melanoma, 14 iris pigment epithelial (IPE) cysts, 7 nevi, 3 Lisch nodules, 2 iris stromal cysts, 1 pars plana cysts, and 1 iris mammillations. An equivalent (100%) visualization of the anterior tumor margin was obtained with both techniques. Compared to AS SS-OCT, UBM was superior for posterior margin visualization in melanocytic tumors and IPE cysts. Bland-Altman plots demonstrated good agreement between UBM and AS SS-OCT for melanocytic tumors < 2.5 mm in base diameter and < 2 mm in thickness. CONCLUSIONS: Although, UBM is the gold standard for ciliary body and iridociliary tumors. AS SS-OCT should be considered as an excellent alternative to UBM, especially in minimally elevated iris lesions.

Influence of Post-radiation Ocular Surface Disorder on Ocular Surgery: A Case Report and Review of the Literature.

BACKGROUND: Ocular surface disorder after ocular radiation therapy, even though commonly reported, is often overlooked. Any delay in diagnosis may lead to complications that threaten vision. The presented case highlights the clinical outcome of a severe post-radiation disorder of the ocular surface, the importance of intensive therapy, and the limitations of further surgical interventions. CASE PRESENTATION: A 34-year-old woman was referred for a second opinion due to a years-long history of pain and redness in her right eye (OD) after proton beam therapy for recurrent iris melanoma. The patient then developed post-radiation retinopathy with macula edema, secondary glaucoma, cataract, as well as a severe ocular surface disorder with corneal decompensation and band keratopathy. Several surgical treatments have been attempted, including phacoemulsification with IOL implantation and trabeculectomy with mitomycin C. Due to refractory glaucoma, Baerveldt glaucoma drainage was then necessary. Given the worsening clinical presentation of post-radiation ocular surface disorder with progressing band keratopathy, the possibility of penetrating keratoplasty (PKP) was discussed. CONCLUSION: The continuous worsening of clinical symptoms of the disorder of the ocular surface after proton beam radiotherapy can be the result of a post-radiation syndrome. Gradual expansion of ischemia, vasculitis, and inflammatory mediators compresses the retinal tissue, leading to recurrent macular edema as well as to secondary glaucoma and corneal decompensation. Band keratopathy is occasionally noted and seems to result from severe post-radiation disorder of the ocular surface. However, PKP would typically be indicated in cases of corneal perforation, uncontrolled infectious keratitis, or for improving vision in the presence of corneal opacification, none of which applied to our patient. Furthermore, post-radiation keratopathy implies compromised corneal stromal lymphogenesis and angiogenesis, both of which are now considered essential conditions for allograft rejection. Moreover, a previously performed Baerveldt glaucoma drainage surgery can affect the survival rate of the endothelial cells of the recipient cornea. Therefore, a penetrating or endothelial keratoplasty should be viewed as a high-risk procedure. In this instance, the rigorous treatment of the severe ocular surface disorder was crucial. We managed our patient's complex situation by following the latest guidelines set by the Tear Film & Ocular Surface Society and aimed to alleviate the symptoms as effectively as possible. In conclusion, careful decision-making regarding surgical treatment options should be considered, taking into account the complexities and potential risks involved.

Cysts and tumours of the iris: Diagnostic tools and key management considerations-A review.

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.

An optimized 3T MRI scan protocol to assess iris melanoma with subsequent histopathological verification - A prospective study.

INTRODUCTION: Magnetic resonance imaging (MRI) has demonstrated high levels of tissue contrast, accuracy and reproducibility in evaluating posterior uveal melanoma. Owing to smaller size, the role of MRI in detecting and characterising iris melanoma has not yet been explored. AIMS: To develop a protocol to image iris melanoma and describe the MRI characteristics of histopathological-confirmed iris melanoma. MATERIALS AND METHODS: An optimised MRI protocol, using a 3T MRI scanner and a 32-channel head coil, was developed to image iris tumours. A prospective, single-centre, 12-month study was conducted on all patients with lesions suspicious for iris melanoma. All patients were offered an MRI scan in addition to the standardised clinical procedures. Image quality comparison was made with existing clinical investigations. Iris melanoma characteristics on MRI are described. RESULTS: A successful optimised MRI scan protocol was developed that was able to detect and characterise iris melanoma. One normal participant and five patients with subsequent histopathological-confirmed iris melanoma (n = 6) were recruited. Four patients completed the full MRI sequence. All iris melanoma were detected on at least one T1- or T2-weighted images. When compared to the vitreous, all iris melanomas demonstrated hyper-intensity on T1-weighted images and hypo-intensity on T2-weighted images. On T1-mapping, T1-values of iris melanoma demonstrated an inverse relationship with the degree of tumour pigmentation. CONCLUSIONS: This study highlights an optimised, easily reproducible MRI scan protocol to image iris melanoma. Numerous MR imaging characteristics of iris melanoma are reported for the first time and a potential non-invasive tumour biomarker is described.

Anterior plaque brachytherapy placement for treatment of iris and iridociliary melanomas - Surgical procedure and institutional experience.

Surgical placement of eye plaque brachytherapy (EPB) is the standard of care for the treatment of uveal melanomas, including iris/iridociliary melanomas. However, unique challenges exist in anterior EPB placement. Here, we describe a surgical technique for anterior EPB placement when placement requires plaque positioning onto the cornea. Blunt conjunctival peritomy exposes the sclera overlying the tumor. A "dummy" plaque is placed, with positioning confirmed by direct visualization. The amniotic membrane is draped across the cornea and anchored with the eyelet sutures, the plaque is placed overlying the membrane, the conjunctiva is closed over the plaque, and a temporary tarsorrhaphy is performed. One week later, the conjunctival incision is reopened for plaque/amniotic membrane removal. This technique was employed in the treatment of 12 iris/iridociliary melanomas at our institution, with no instances of corneal damage. In placing an anterior plaque, employing this technique allows appropriate cancer treatment while optimizing patient comfort and corneal integrity.

Outcome of combined cataract surgery and iris prosthesis implantation in iris melanoma patients previously treated with iridocyclectomy: A national retrospective non-comparative case series.

PURPOSE: To examine complications, visual outcomes, photic patient-reported symptoms, corneal morphology, IOL tilt, and intraocular pressure after implantation of an intraocular lens (IOL) and iris prosthesis (IP) following iridocyclectomy. METHODS: Patients with previous iridocyclectomy treated with an IOL and IP at the Copenhagen University Hospital Rigshospitalet between 2007 and 2018 were included in this national retrospective non-comparative case series. The assessment encompassed BCVA, PRO questionnaire, corneal topography, and anterior segment OCT. RESULTS: 45 patients were included. Eight of 45 patients were previously treated with ruthenium-106 brachytherapy in conjunction with iridocyclectomy. Six of 45 patients developed endothelial dysfunction four of whom had received ruthenium-106 brachytherapy. Five of 45 patients had subluxation of the IOL/IP complex due to incomplete zonula apparatus. BCVA improved for all patients after lens surgery. 26 patients participated in the invited follow-up examination. 19 of 26 (73%) reported none or mild photic symptoms after IP instalment. Five (19%) reported ongoing severe photic symptoms. The corneal astigmatism significantly increased after iridocyclectomy but did not change after lens surgery. CONCLUSIONS: Implantation of an IOL and IP is a safe procedure, alleviating photic symptoms in most patients. It comes with higher risk of complications due to a more demanding procedure and larger surgical traumas from previous treatments. Ruthenium-106 brachytherapy increases the complication risk. Corneal astigmatism is induced by iridocyclectomy but does not change after lens surgery.

Symptomatic primary iris cysts treated with frequency-doubled Nd: YAG laser photocoagulation / Cistos irianos primários sintomáticos tratados com fotocoagulação a laser de Nd: YAG de dupla frequência

Abstract We report the case of a 31-year-old woman who presented with a nine-month history of blurred vision in her left eye. Slit-lamp examination and optical coherence tomography showed four cystic masses hanging at the pupillary margin of the left eye. Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) laser photocoagulation was used to rupture the wall (cystotomy), drain the cyst content and shrink the remnants of the pigment epithelium, using laser parameters at the lowest effective levels. The patient's best corrected visual acuity improved significantly after treatment. Despite the increase of pigment at anterior chamber angle, no complication was observed during 6 months of follow up. This is the first report to describe frequency-doubled Nd:YAG laser (532 nm) photocoagulation as a therapeutic option for patients with symptomatic primary IPE cysts at pupillary margin.

Resumo Relatamos o caso de uma mulher de 31 anos com queixa de visão turva no olho esquerdo. Exame em lâmpada de fenda e tomografia de coerência óptica mostraram quatro lesões císticas nas margens da pupila esquerda. O laser do tipo Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) de dupla-frequência foi o tratamento de escolha para romper a parede (cistotomia), drenar o conteúdo do cisto e encolher os remanescentes do epitélio de pigmentar utilizando os menores parâmetros efetivos. Após o tratamento do olho comprometido, sua acuidade visual melhorou consideravelmente. Apesar do aumento da pigmentação no ângulo da câmara anterior, nenhuma complicação foi observada durante 6 meses de acompanhamento. Este é o primeiro relato que descreve o laser de Nd:YAG de dupla frequência (532 nm) como uma opção terapêutica para pacientes com cistos irianos primários do epitélio pigmentar sintomáticos na margem pupilar.

Iris metastases from systemic cancer: a report of three cases / Metástase de íris de câncer sistêmico: relato de três casos

ABSTRACT Ocular metastasis is relatively uncommon, with a reported incidence of approximately 8%, according to the results of autopsy evaluation. The majority of ocular metastases are located within the choroid, while metastatic tumors affecting the iris are rare. Metastatic tumors may manifest as stromal nodules or ill-defined iris thickening, or they may present with nonspecific features such as pain, iridocyclitis, and hyphema. Here, we describe three patients with iris metastasis and discuss the diagnostic challenges and unusual findings associated with these cases.

RESUMO A maioria das metástases oculares do câncer sistêmico são encontrados na coroide. As metástases para a íris são incomuns, podendo se manifestar como nódulo estromal, espessamento de íris de limites mal definidos ou como uma iridociclite ou hifema. Relatamos 3 pacientes com lesão de íris e história pregressa de câncer sistêmico. Enfatizamos a dificuldade no diagnóstico e raridade dessas lesões comparando com relatos anteriores.

Biomicroscopia ultra-sônica (UBM) no planejamento cirúrgico e acompanhamento pós-operatório de melanomas malignos de íris e corpo ciliar / Ultrasound biomicroscopy (UBM) in the surgical planning and postoperative follow-up of iris and ciliary body melanomas

OBJETIVO: Estudar os achados da biomicroscopia ultra-sônica (UBM) em melanomas malignos primários da íris e corpo ciliar antes e depois da resecçäo cirúrgica e correlacionar a extensäo do tumor (revelado pela biomicroscopia ultra-sônica) aos achados histopatológicos. MÉTODOS: Estudo prospectivo de 5 pacientes com diagnóstico clínico de tumor de íris e/ou corpo ciliar. Estes pacientes foram avaliados pela biomicroscopia ultra-sônica antes e após iridociclectomia ou iridectomia. Os espécimens foram enviados para estudo histopatológico. Os pacientes foram acompanhados por período mínimo de 6 meses quando foi realizada nova biomicroscopia ultra-sônica. RESULTADOS: Neste grupo de 5 pacientes, 3 eram do sexo feminino e 2, do masculino, variaçäo de idade de 32 e 64 anos. Todos os casos eram unilaterais. Quatro pacientes apresentaram massa iridociliar e um apresentou lesäo limitada à íris. Em todos os casos a biomicroscopia ultra-sônica auxiliou o planejamento cirúrgico para a ressecçäo tumoral com margens livres. A biomicroscopia ultra-sônica no pós-operatório revelou ausência de crescimento tumoral em todos os casos, sendo que 2 pacientes apresentaram vítreo na incisäo cirúrgica, 1 deles com traçäo vítrea leve, mas sem sinais de descolamento de retina. CONCLUSÄO: A biomicroscopia ultra-sônica pareceu ser método auxiliar confiável para diagnosticar tumores de íris e corpo ciliar, planejar o tratamento cirúrgico e o acompanhamento pós-operatório

Correlação entre a citologia e a histologia nas lesões intra-oculares suspeitas de malignidade / Cytologic-histologic correlation in intraocular lesions with suspicion of malignancy

OBJETIVO: Correlacionar os achados citológicos da biópsia aspirativa com agulha fina (BAAF) de lesões intra-oculares suspeitas de malignidade com a histopatologia obtida quando o tratamento de escolha foi enucleação ou ressecção da lesão tumoral. MÉTODOS: Análise retrospectiva de 51 pacientes submetidos à biópsia aspirativa com agulha fina com fins diagnósticos ou para correlação cito-histológica. Foram excluídos os casos com lesões não sólidas, tratamento conservador e biópsias guiadas por ultrasom. Após exclusões, 20 olhos de pacientes contendo lesões intra-oculares suspeitas de malignidade foram estudados, sendo 12 do sexo feminino, com idades entre 2 e 78 anos. Todas biópsias foram realizadas pela primeira autora sob observação direta (microscópio) ou indireta (oftalmoscopia binocular indireta). A rota escolhida foi transaquosa para os tumores de segmento anterior e transvítrea com acesso escleral para os tumores de segmento posterior, exceto os casos suspeitos de retinoblastoma, biopsiados com acesso pela periferia da córnea. Foram obtidas 2 amostras de áreas diferentes do tumor em todos os casos com agulha calibre 25. As amostras colhidas foram encaminhadas para processamento, fixação e coloração pelo método de Papanicolaou e hematoxilina-eosina. Os espécimens obtidos para histopatologia foram corados pela hematoxilina-eosina. RESULTADOS: Três casos eram tumores de segmento anterior (íris) e 17 de segmento posterior, sendo 3 retinoblastomas. Nove pacientes foram submetidos à biópsia aspirativa com agulha fina com fins diagnósticos e 11 para correlação cito-histológica após enucleação. Somente dois casos apresentaram quantidade insuficiente de material para diagnóstico e posteriormente revelaram ser um granuloma e um melanoma maligno de coróide. CONCLUSÕES: A biópsia aspirativa com agulha fina parece ser um método diagnóstico confiável baseado na correlação cito-histológica neste grupo de pacientes.

Carcinoma ductal de mama com metástase para íris em paciente com nevus melanocítico da coróide: relato de caso / Metastatic breast cancer to the iris in patient with choroidal melanocitoma: case report

Objetivo: Alertar para a possibilidade do diagnóstico precoce de neoplasias sistêmicas com manifestação metastática ocular. Local: Hospital Geral de Fortaleza/SUS - Laboratório BIOPSE, Fortaleza - CE. Método: Relato de caso de uma paciente de 52 anos com história de mastectomia radical apresentando, 8 meses depois, baixa da acuidade visual e dor ocular intensa. Resultados: O exame oftalmológico evidenciou hiperemia conjuntival moderada, sinéquias posteriores exsudato fibrinóide vindo, posteriormente, à íris, e tumefação no terço externo inferior. A paciente apresentou hipermetropização inicialmente de +1.00D e, posteriormente, de +2.50D no OD, com manutenção da acuidade visual corrigida. Com o seguimento evidenciou-se mudança no aspecto da lesão e aumento da dor, sendo indicada a enucleação. O exame anatomopatológico concluiu tratar-se de carcinoma infiltrante de mama, com metástase para íris e melanocitoma de coróide. Conclusão: Apesar de raro, o carcinoma metastático de íris deve fazer parte do diagnóstico diferencial de afecções oculares em pacientes com neoplasias sistêmicas.

Melanoma de tejido uveal / Uveal melanoma

El melanoma del tracto uveal es el tumor intraocular primario más frecuente en el adulto y se asocia a una alta incidencia de metástasis. Clínicamente puede ser asintomático y descubrirse en el transcurso de una exploración oftalmológica o manifestarse como una masa tumoral que desprende la retina ocasionando pérdida de la función visual. Su diagnóstico se basa en los hallazgos oftalmoscópicos, fluorangiográficos y ecográficos, además de existir pruebas inmunohistoquímicas específicas que determinan su terapéutica en gran medida.La presente sección muestra imágenes ecográficas características de esta patología enfatizando la importancia de este estudio en su diagnóstico.

Estudo do segmento anterior com biomicroscopia ultra-sônica em bloqueio pupilar / Anterior segment study with ultrasound biomicroscopy

Foram estudados quinze pacientes com diagnóstico de ângulo estreito com bloqueio pupilar relativo, através de novo sistema de imagem, a biomicroscopia ultra-sônica de ângulo estreito com bloqueio pupilar relativo. O objetivo do estudo foi medir nestes pacientes o arco de contato írido cristaliniano (ACIC), a abertura do ângulo a 500 (AA500), a distância trabéculo processos ciliares (DTPC) e a espessura da íris periférica (El1); comparar estas medidas ás existentes em pacientes normais e em pacientes com "íris em plateau"; analisar estatisticamente estes dados, para tentar verificar a real importância do arco de contato írido cristaliniano na gênese do bloqueio pupilar relativo e tentar esclarecer outros fatores anatômicos envolvidos na fisiopatologia dos bloqueios pupilares relativos.

Carcinoma metatástico de íris: descriçäo de 2 casos / Metastic carcinoma of the iris: 2 case reports

Descrevemos 2 casos de carcinoma metastático para o segmento anterior ocular. Apesar da raridade desta patologia é importante suspeitar de tal diagnóstico ao avaliar tumoraçöes em segmento anterior e proceder a investigaçäo clínica adequada. Nos 2 casos descritos, a hipótese diagnóstica de metástase foi feita pelo exame oftalmológico. Os pacientes näo apresentavam queixa sistêmica e näo tinham o diagnóstico do tumor primário. Em um dos casos, o diagnóstico foi confirmado pela biópsia aspirativa, sugerindo ser um instrumento valioso no diagnóstico desta patologia

Retirada cirúrgica de tumor de iris, corpo ciliar e coróide, de grandes proporçöes / Surgical removal of iris tumor, ciliary body and choroid, of great proportions

O presente trabalho descreve um caso de retirada cirúrgica de um leiomioma que atingia íris, corpo ciliar e coróide (até quase o equador do globo ocular) e a manutençäo de visäo de 20/20 no olho operado. Foi realizada a retirada completa do tumor com margem de segurança de 2 mm. Fazem-se consideraçöes sobre o diagnóstico diferencial e manejo adequado destes tumores, bem como, a possibilidade da excisäo completa mantendo boa acuidade visual com o uso de técnicas cirúrgicas avançadas