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Abstract #6449 Published in IGR 3-2
Factors associated with elevated intraocular pressure in eyes with iris melanoma
Shields CL; Materin MA; Shields JA; Gershenbaum E; Singh AD; Smith ABritish Journal of Ophthalmology 2001; 85: 666-669
AIM: To identify clinical factors associated with secondary elevated intraocular pressure (IOP) in eyes with iris malignant melanoma. METHODS: A retrospective case series of 169 consecutive patients with microscopically confirmed iris malignant melanoma. The main outcome measure was the presence of tumor-induced secondary elevated IOP. Cox proportional regression models were used to calculate the relation of clinical features to elevated IOP. RESULTS: Of 169 patients with microscopically-proven iris melanoma, 50 (30%) presented with tumor-induced secondary elevated IOP. The mean pressure in those eyes with elevated IOP at diagnosis was 33 mmHg (median 31 mmHg; range, 23-64 mmHg). The tumor configuration was nodular in 23 (46%) and diffuse in 27 (54%), with a mean base dimension of 7.4 mm and thickness of 2.0 mm. Invasion of the angle structures by melanoma seeds was visible for a mean of seven clock hours (median, seven; range, 0-12 clock hours). The mechanism of elevated IOP was judged to be outflow obstruction from tumor invasion into the trabecular meshwork. There were no cases of neovascular glaucoma. The tumor was ultimately managed with enucleation in 30 patients (60%), local resection (iridectomy, iridocyclectomy, or iridocyclogoniectomy) in 11 (22%), and plaque radiotherapy in five (10%). In four cases (8%), observation of cytologically low grade tumor was the patient's preference. Using multivariate analysis, the clinical factors at initial evaluation associated with tumor-induced secondary elevated IOP from iris melanoma included increasing extent of tumor seeding in the anterior chamber angle (p = 0.01) and poor visual acuity at presentation (p = 0.02). CONCLUSIONS: Microscopically confirmed iris melanoma demonstrates tumor-related elevated IOP in 30% of cases at the time of presentation, usually secondary to tumor involvement of the trabecular meshwork obstructing aqueous outflow. Enucleation is necessary in the majority of these patients (60%) compared to those cases without elevated IOP (18%).
Dr C.L. Shields, Oncology Service, Wills Eye Hospital, 900 Walnut Street, Philadelphia, PA 19107, USA
Classification:
9.4.8 Glaucomas associated with intraocular tumors (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders)
