Minimal iris touch excision: a novel surgical technique for local excision of iris melanoma

Meyer, Jay J.; Krishnan, Thiyaga; McGhee, Charles N J

doi:10.1111/ceo.13041

Cited by 8 publications

(8 citation statements)

References 3 publications

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“…Furthermore, the advent of novel surgical techniques in combination with rehabilitative techniques, such as insertion of an artificial iris, reduces the treatment-associated burden of disease. 15…”

Section: Discussionmentioning

confidence: 99%

“…An excisional biopsy provides dual diagnostic and therapeutic functions; the lesion is removed, and the histological diagnosis provides an estimation of prognosis. Furthermore, the advent of novel surgical techniques in combination with rehabilitative techniques, such as insertion of an artificial iris, reduces the treatment-associated burden of disease 15 …”

Section: Discussionmentioning

confidence: 99%

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Case Series: Different Presentations of Iris Melanoma—Potential Masquerade of Benign and Malignant

et al. 2021

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Iris melanoma and iris nevi can be challenging to distinguish clinically. This case series provides unique insight into the rare condition and variable clinical presentations of iris melanoma.PURPOSE: This study aimed to highlight the varying clinical presentations of iris melanoma and to demonstrate the overlapping features of melanoma and nevi.CASE REPORTS: This case series includes five patients of varying age and sex who presented to clinic with pigmented iris lesions. These five patients have differing timeline to presentation and very different clinical presentations of their lesions. Clinical evaluation was based around the established "ABDCEF" guide for the assessment of malignant risk in iris lesions. The presentation of each lesion is discussed in relation to this guide and the experienced clinician's clinical suspicion of malignancy. When comparing the clinical suspicion with histological analysis, after biopsy, the result may be unexpected. Notably, initially benign nevi may transform into melanoma over time. These five cases were managed on an individual basis because the management and prognosis of iris melanomas vary significantly. Importantly, iris melanotic lesions have variable metastatic risk based on cytology and genetic predisposition. Informed consent was obtained from all the patients, institutional approval was obtained, and no identifiable health information is included in this case series.CONCLUSIONS: When presented with a pigmented iris lesion, clinicians must be vigilant with regular monitoring and have a low threshold for biopsy in pigmented lesions of high clinical suspicion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Case Series: Different Presentations of Iris Melanoma—Potential Masquerade of Benign and Malignant

et al. 2021

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“…Using the Minimal Iris Touch Excision (MITE) technique. 11 All excision biopsies were conducted with a tumor margin of ≥1 mm of macroscopically uninvolved tissue. After incisions free the iris biopsy, the tissue passes from the anterior chamber, by capillary action and pressure differential, into an IOL cartridge (without touching the corneal incision or ocular surface), and is then gently flushed onto pre-cut filter paper, gently spread flat, and secured under a second sheet of filter paper in a cartridge.…”

Section: Methodsmentioning

confidence: 99%

Tumor Profiles of Late Presentation Uveal Ring Melanoma With Novel Characteristics – A Case Series

Lim,

Crawford,

McGhee

2023

Invest. Ophthalmol. Vis. Sci.

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Purpose The purpose of this study was to investigate the clinical features, tumor characteristics, including histopathology and cytogenetic analysis, and management of patients with uveal ring melanoma in New Zealand. Methods A retrospective review was conducted on all uveal melanoma cases treated in a single national oncology center in New Zealand. The study period was from January 1, 2013 to December 31, 2022 (10 years). Written consent was obtained from all patients included in this case series. Results Uveal ring melanoma of ciliary body origin ( n = 4) comprised 0.7% of all uveal melanomas ( n = 571). Ethnicity distribution was three patients of New Zealand European ancestry and one patient of Chinese/Pasifika ancestry. Three patients (75%) were symptomatic at presentation (spontaneous hyphema, glaucoma, and cataract), whereas one was asymptomatic but subsequently developed painful refractory glaucoma. All eyes underwent enucleation. Three eyes had primary iris biopsies with subsequent enucleation for refractory glaucoma and pain and one eye underwent primary enucleation. All cases demonstrated malignant tumor characteristics including diffuse 270 to 360-degree ciliary body ring growth pattern, epithelioid-cell type and presence of either BAP-1 expression loss or gain of MYC gene. Two cases (50%) developed distant organ metastasis – liver, parotid gland, and breast. Of those, one patient was deceased at the time of follow-up whereas one had completed treatment for metastases. Conclusions Uveal ring melanoma is a rare tumor that is highly invasive and malignant. When detected, prompt definitive treatment should be advocated, and patient counselling should be given regarding the high risk of developing a painful, blind eye with increased risk of metastasis in the absence of treatment.

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“…Indeed, it has been postulated that the intraoperative and postoperative complications after endocapsular techniques may be comparable to those in standard intraocular lens (IOL) implantation 1 . Our centre provides a tertiary service for anterior segment trauma and anterior segment ocular tumours, specifically iris and ciliary body tumours 10 . Our team is therefore regularly involved in all aspects of iris reconstruction.…”

Section: Introductionmentioning

confidence: 99%

“…1 Our centre provides a tertiary service for anterior segment trauma and anterior segment ocular tumours, specifically iris and ciliary body tumours. 10 Our team is therefore regularly involved in all aspects of iris reconstruction. Here we report the results of, to our knowledge, the largest consecutive series to date of endocapsular placement of the HumanOptics CustomFlex ® Artificial Iris.…”

Section: Introductionmentioning

confidence: 99%

Endocapsular artificial iris implantation for iris defects: Reducing symptoms, restoring visual function and improving cosmesis

Crawford

Freundlich

Lim

et al. 2022

Clinical Exper Ophthalmology

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Background: To investigate repair of iris defects by endocapsular implantation of an artificial iris, in relation to visual outcomes, safety profile and patient satisfaction.Methods: Retrospective, consecutive case series from Greenlane tertiary teaching hospital and Eye Institute, Auckland, New Zealand. Medical records of patients implanted with an endocapsular artificial iris were reviewed and followed for minimum 3 months. Patient characteristics, surgical management, clinical outcomes and subjective responses were recorded.Results: Nineteen artificial irises were implanted in 18 patients. Etiologies were iris melanotic lesion excision (73.7%), trauma (10.5%), congenital aniridia (10.5%) and Urrets-Zavalia syndrome (5.3%). During postoperative follow-up [14.1 ± 12.4 months (range: 3 to 59 months)], best corrected visual acuity (BCVA) and intraocular pressure (IOP) did not change significantly [BCVA, 0.23 logarithm of the minimum angle of resolution (logMAR) (20/32 Snellen) preoperatively vs. 0.18 logMAR postoperatively (20/25 Snellen) (Z = À0.222, p = 0.824); IOP, 15 mmHg preoperatively vs. 17 mmHg postoperatively (Z = 1.377, p = 0.1447)]. Mild or self-limiting complications included: elevated IOP (42.1%), cystoid macular oedema (15.8%); persisting postoperative uveitis (15.8%) and minor vaulting of the prosthesis (15.7%). Moderate or severe complications included significant vaulting of prosthesis requiring surgical revision (5.3%) and a single eye (5.3%) with trabeculectomy and corneal graft failure. 94.4% of patients were very satisfied with the cosmesis and would be highly likely to have the procedure again. Conclusions: This study confirms that endocapsular insertion of an artificial iris is typically associated with good functional and cosmetic results and a relatively low risk of significant complications.

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Minimal iris touch excision: a novel surgical technique for local excision of iris melanoma

Cited by 8 publications

References 3 publications

Case Series: Different Presentations of Iris Melanoma—Potential Masquerade of Benign and Malignant

Case Series: Different Presentations of Iris Melanoma—Potential Masquerade of Benign and Malignant

Tumor Profiles of Late Presentation Uveal Ring Melanoma With Novel Characteristics – A Case Series

Endocapsular artificial iris implantation for iris defects: Reducing symptoms, restoring visual function and improving cosmesis

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