Characteristics of anterior uveal melanocytomas in 17 cases.

OBJECTIVE: To evaluate a case series of anterior uveal melanocytomas (AUMs) for their distinct clinical, histopathologic, and high-frequency ultrasound (UBM) characteristics. DESIGN: Retrospective single-center case series. PARTICIPANTS: Seventeen consecutive patients with AUMs. METHODS: Retrospective review of patient, tumor, UBM, histopathologic, and follow-up characteristics. Follow-up data included change in visual acuity, growth, secondary glaucoma, extrascleral extension, or malignant transformation. MAIN OUTCOME MEASURES: Tumor, high-frequency ultrasound, histopathologic, and follow-up characteristics. RESULTS: Seventeen patients had a median follow-up of 20 months (range, 1-130). Tumor was darkly pigmented with nodular configuration in 100% of patients, irregular surface in 82% of patients, characteristic cobblestone surface appearance in 59% of patients, and feathery or fimbriated margins in 88% of patients. Intrinsic vascularity, ectropion uveae, episcleral sentinel vessel, sector cataract, or heterochromia was not seen. High-frequency ultrasound showed high (71%) or moderately high (12%) internal reflectivity in the majority of tumors. Thirteen tumors (76%) involved the iris, 47% of tumors were club-shaped, and 100% of tumors showed no intrinsic vascularity. Mean tumor thickness was 1 mm (standard deviation [SD] ± 0.5, median 0.9, range 0.3-2.1 mm). Mean largest basal dimension was 3.1 mm (SD ± 2.3, median 2.3, range 0.5-9.4 mm) (n=14). Three pathologic evaluations revealed plump polyhedral cells with abundant cytoplasm, small round to oval nuclei, inconspicuous nucleoli, and finely dispersed chromatin. Two tumors had extrascleral extension, 2 tumors were documented to grow, and 1 tumor caused medically controlled glaucoma. CONCLUSIONS: Anterior uveal melanocytomas are uncommon benign melanocytic tumors with characteristic clinical features. High-frequency ultrasound imaging offers excellent views of obscure posterior extent and allows precise tumor measurement and monitoring for growth. It is an invaluable adjunct to digital slit-lamp photography for evaluating tumor stability or growth. This study presents and correlates unique clinical, high-frequency ultrasound and histopathologic characteristics.

Transpupillary Nd:YAG laser cystotomy for iris pigment epithelial cysts with secondary progressive angle closure.

Two patients were diagnosed as having unilateral iris pigment epithelial (IPE) cysts that were documented to enlarge and induce angle closure. Transpupillary IPE cystotomies were performed using the Nd:YAG laser as a prophylactic measure to prevent angle-closure glaucoma. Anterior chamber anatomy and cyst dimensions were assessed before, during, and after long-term follow-up using slit-lamp biomicroscopy, gonioscopy, and 20- or 35-MHz high-frequency ultrasound imaging. Cystotomy resulted in immediate, visible deflation of both IPE cysts with subsequent resolution of angle closure. The cyst contents appeared clear and no secondary inflammation or glaucoma occurred. No evidence of cyst recurrence has been noted during 3 and 8 years of follow-up, respectively. Transpupillary Nd:YAG laser cystotomy offered a minimally invasive and effective treatment for angle closure induced by progressive IPE cysts.