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Anterior Segment Examination Upon further examination, the sentinel vessels led towards a mass in the anterior chamber Inferotemporal non-pigmented mass with apparent vascular supply overlying iris, entering vs. originating from the angle This is presumed to be progression from the suspicious nevus previously documented
The right eye had sentinel blood vessels, more apparent in the inferotemporal quadrant, as depicted above.
Chief complaint: Presented for redness of the right eye, no other complaints.Entering VA OD: 20/20, OS: 20/20Goldmann tonometry: 16/16 mmHgAnterior segment examination of the right eye reveals tortuous sentinel vessels on the conjunctiva and an amelanotic lesion on the iris. The left eye was within normal limits.
HistoryA 57 year old female presents for evaluation of an iris nevus OD.She was seen in contact lens clinic originally and was referred after an iris nevus was discovered with suspicious characteristics.The patient was instructed by ocular oncology to follow up in 3 months.However, after being referred, the patient was lost to follow up
Features of Iris Melanoma Shields et al described iris melanoma as having: replaced the iris stroma, 3 mm diameter, and 1 mm thickness.Diagnosis requires 3 of 5 features:Photographic evidence of growthSecondary cataractSecondary glaucomaConspicuous vasculatureIris ectropionAngle involvement can lead to secondary glaucoma.Jakobiec and Silbert noted that the involvement of the ciliary body most strongly indicates malignancy,
IntroductionUveal melanoma are the most common intraocular tumors.The iris is the least likely location for a uveal melanoma to arise (2-5%).Iris melanomas have younger onset than other uveal melanomas (average 46 years old).Iris melanomas have been on the rise, likely due to UV ray exposure, and more likely from the clock hours of 5
Part 3: Amelanotic Malignant Uveal Melanoma
References: Finger PT: Plaque radiation therapy for malignant melanoma of the iris and ciliary body. Am J Ophthalmol 132 (3): 328-35, 2001.Char DH, Miller T, Crawford JB: Uveal tumour resection. Br J Ophthalmol 85 (10): 1213-9, 2001.De Potter P: [Choroidal melanoma: current therapeutic approaches] J Fr Ophtalmol 25 (2): 203-11, 2002.Costache M, Patrascu OM,
Acknowledgement Thank you to Dr. Jerry Sherman for providing this case study and images. Jerome Sherman, OD, FAAOSUNY Distinguished Teaching Professor
About the Author Dr. Diana Doscas is a graduate of SUNY Optometry Class of 2023 from Mahopac, NY. Dr. Doscas is currently a resident in Primary Care Optometry/Ocular Disease at the VA Hudson Valley Health Care System in Hudson Valley, New York.
