Clinical survey of 3680 iris tumors based on patient age at presentation.

OBJECTIVE: To report the spectrum of iris lesions based on patient age at presentation. DESIGN: Retrospective, nonrandomized, single-center case series. PARTICIPANTS: We included 3680 iris tumors in 3451 patients. METHODS: Chart review. MAIN OUTCOME MEASURES: Diagnostic category based on age. RESULTS: The mean age at presentation was 48 years and there were 449 (12%) tumors in children (≤20 years), 788 (21%) in young adults (21-40 years), 1308 (36%) in mid adults (41-60 years), and 1135 (31%) in senior adults (>60 years). Of 3680 tumors, the diagnostic category was cystic (n = 768; 21%) or solid (n = 2912; 79%). The cystic tumors originated from iris pigment epithelium (IPE; n = 672; 18%) or iris stroma (n = 96; 3%). The solid tumors included melanocytic (n = 2510; 68%) and nonmelanocytic (n = 402; 11%). The melanocytic tumors comprised nevus (n = 1503; 60%), melanocytoma (n = 68; 3%), melanoma (n = 645; 26%), and melanocytosis (n = 64; 3%). Of 2510 melanocytic tumors, the first and second most common diagnoses by age (children, young adult, mid adult, senior adult) were nevus (53%, 57%, 63%, and 63%, respectively) and melanoma (17%, 27%, 26%, and 27%, respectively). The nonmelanocytic tumors included categories of choristomatous (n = 4; <1%), vascular (n = 57; 2%), fibrous (n = 2; <1%), neural (n = 3; <1%), myogenic (n = 2;, <1%), epithelial (n = 35; 1%), xanthomatous (n = 8; <1%), metastasis (n = 67; 2%), lymphoid (n = 12; <1%), leukemic (n = 2; <1%), secondary (n = 12; <1%), and nonneoplastic simulators (n = 198; 5%). The median age (in years) at diagnosis included cystic (39), melanocytic (52), choristomatous (0.7), vascular (56), fibrous (53), neural (8), myogenic (42), epithelial (63), xanthomatous (1.9), metastasis (60), lymphoid (57), leukemic (25.5), secondary (59), and nonneoplastic simulators (49). Overall, the 3 most common specific diagnoses (children, young adult, mid adult, senior adult) were nevus (25%, 36%, 47%, and 47%, respectively), IPE cyst (28%, 30%, 15%, and 14%, respectively), and melanoma (8%, 16%, 20%, and 19%, respectively). CONCLUSIONS: In an ocular oncology practice, the spectrum of iris tumors includes cystic (21%) and solid (79%) tumors. The solid tumors were melanocytic (68%) or nonmelanocytic (11%). At all ages, the most common specific diagnoses were nevus (42%), IPE cyst (19%), and melanoma (17%).

A new technique for diode laser cyclophotocoagulation.

Destruction of the ciliary body, an option in glaucoma surgical treatment, can be performed using various methods. Laser energy, now the principle source for cyclodestruction, can be delivered in a transpupillar, transvitreal in conjunction with a vitrectomy and transscleral manner. The current technique for endocyclophotocoagulation requires of an endoscopic probe. We describe an accessible and inexpensive alternative. Gonioprism-assisted diode cyclophotocoagulation (GADC) with a peripheral corneal approach is a new surgical technique for pseudophakic and aphakic patients that uses a manual gonioprism, iris hooks, ophthalmic operating microscope, and an 810-nm laser diode probe. GADC is performed under topical and intracameral anesthesia, prior pupil dilation. First, 4 iris hooks are placed to expose the posterior chamber. The ciliary processes are viewed through a Swan-Jacob gonioprism and the diode laser probe is inserted through a peripheral corneal incision. The energy of the laser is set at 250 mW and the duration of the application to each process is variable, from 500 to 800 ms, until shrinkage and whitening occur. We apply this technique in approximately 360 degrees of the ciliary processes. Subconjunctival dexamethasone phosphate is administered at the end of the surgery prior subconjunctival injection of lidocaine. GADC has a relatively quick learning curve, allows direct visualization with less energy delivered to the ciliary processes and obviates the acquisition of a new endoscopic device.