Ординатура / Офтальмология / Английские материалы / Tumors of the Eye and Ocular Adnexa_Char_2001

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DIAGNOSIS OF IRIS MASS LESIONS

The most common adult iris lesions are nevi, melanomas, and cysts. Other lesions that simulate melanoma include the Cogan-Reese or essential iris atrophy variants of the iridocorneal endothelial (ICE) syndrome, epithelial downgrowth, medulloepithelioma, nodular adenomatosis, leiomyoma, metastasis, iris foreign body, lymphoid tumors, neurofibromatosis, hemangioma, inflammatory lesions, neurofibroma, aberrant lacrimal tissue, peripheral anterior synechiae, and inflammatory iris atro- phies.1–9 In children, and rarely in adults, juvenile xanthogranuloma (JXG) can involve either the iris or the ciliary body.10–14

Iris Cysts

The diagnosis of iris cysts is usually straightforward.15 Patients are often young and have either had trauma or prolonged treatment with topical miotic agents.16 Nontraumatic lesions, usually within the pigment epithelium, remain stationary, while those associated with trauma often grow; occasionally, after surgery, a free-floating iris cyst can develop. The overlying anterior iris surface is not disrupted in the pigment epithelial cysts (Figure 9–1); in contrast, this is quite common with stromal cysts (Figure 9–2). Iris melanomas alter the anterior iris surface; however, isolated ciliary body melanomas do not.

Iris pigment cysts can occur in any position on the posterior surface of the iris (Figure 9–3). Retroillumination at the slit-lamp or scleral transillumination demonstrates the cystic nature of these lesions and allows differentiation from iris-ciliary body

melanomas. Cysts transilluminate easily while melanomas block light. Ultrasonography can demonstrate the cystic nature of both iris and ciliary body cysts; however, we and others have observed histologically confirmed ciliary body melanomas that appeared cystic on ultrasound examination. The newer high-frequency ultrasonography demonstrates these benign posterior pigment cysts very easily (Figure 9–4). What is unclear is how specific the finding of a cystic lesion is, using high-frequency ultrasonography. Certainly, a solid tumor that has a cystic component should still be viewed with suspicion and a biopsy performed.

Recently, a case has been reported of an iris cyst after the use of latanoprost (Xalatan).17 Rarely, argon or Nd:YAG laser is used to demonstrate the cystic nature of a lesion, which will collapse after a laser burst, versus a solid melanoma which will not.15–18

Congenital iris stromal cysts are difficult to manage, since enlargment has occurred in 21 of

Figure 9–1. Posterior pigmented iris cyst with normal anterior iris surface.