Melanomalytic glaucoma secondary to iris melanoma

Abstract

Purpose To report on an unusual form of adult onset iris melanoma as melanomalytic glaucoma. Methods A 35‐year‐old white male with a history of unilateral ocular hypertension and visual loss for six months. Results At first visit,Best Corrected Visual Acuity was 80/20 in the right eye (OD) and 20/20 in the left one (OS).Intraocular pressure was 40 mmHg in the OD and 10 mmHg in OS.Anterior segment examination of the OD showed a melanotic elevated lesion on the base of the iris from 8:00 to 9:00.Gonioscopy revealed extension into the anterior chamber angle and that a dense, brown, pigmented band at the filtration portion of the trabecular meshwork. Ophthalmoscopy demonstrated glaucomatous changes to the right optic disc. The patient was unresponsive to medical treatment for glaucoma. The clinical differential diagnosis was melanocytoma, nevus and melanoma. Excisional biopsy ( iridocycloresection ) was performed. Light microscopy showed proliferation of fusiform cells with pleomorphic nuclei in the iris stroma, immunopositive for HMB45 and Melan‐A. The final hystopathologic diagnosis was iris melanoma with dispersion of pigment in anterior‐chamber and secondary melanomalytic glaucoma. Plaque radiotherapy was performed as a Conclusion In patients presenting unilateral glaucoma and increased pigmentation in the trabecular meswork it is crucial to perform imaging studies, such as ultrasound, in order to rule out the presence of an intraocular tumor. Early diagnosis improves the patients visual prognosis and the morbidity of treatments. Resection by iridectomy with adjuvant epiescleral brachytheraphy is effective in controlling the disease.