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. 1999 Feb;83(2):194–198. doi: 10.1136/bjo.83.2.194

Ring melanoma—a rare cause of refractory glaucoma

V Lee 1, I Cree 1, J Hungerford 1
PMCID: PMC1722943  PMID: 10396198

Abstract

BACKGROUND—Ring melanoma of the ciliary body and iris is extremely rare and often has adverse histology. This tumour may cause raised intraocular pressure.
METHODS—A review of four cases of ring melanomas with insidious presentations seen in the ocular oncology service over a 12 month period.
RESULTS—All four patients presented with unilateral anterior segment abnormalities and refractory glaucoma. The misdiagnoses of the causes of the glaucoma included angle recession from previous blunt trauma (patient 1); iridocorneal endothelial (ICE) syndrome supported by endothelial specular microscopy (patients 2 and 3); and melanocytoma on ciliary body biopsy (patient 4). Two patients were treated by several cyclodiode ciliary body ablation treatments and the other two underwent trabeculectomies and Molteno tubes. Two of the four patients have since died from their disease.
CONCLUSION—The ophthalmologist should re-evaluate the diagnosis in patients with anterior segment abnormalities and refractory ipsilateral glaucoma. Endothelial specular microscopy and biopsy of the suspicious lesion may give misleading reassurance. The potential presence of an anterior uveal melanoma must always be considered.

 Keywords: ring melanoma; iridocorneal endothelial syndrome; glaucoma; uveal melanoma

Full Text

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Figure 1  .

Figure 1  

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Circumcorneal dark shadow of ring melanoma.

Figure 2  .

Figure 2  

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Conjunctival nodule of extrascleral extension of ring melanoma.

Figure 3  .

Figure 3  

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Low power view of the iris in the enucleation specimen showing an extensive melanocytic lesion filling the angle, invading the trabecular meshwork, and replacing the iris. (Haematoxylin and eosin, original magnification, ×20).

Figure 4  .

Figure 4  

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Focal lens opacity.

Figure 5  .

Figure 5  

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Sentinel vessel over pigmented iridociliary lesion.

Figure 6  .

Figure 6  

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Darkly pigmented angle on gonioscopy.

Figure 7  .

Figure 7  

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Obliteration of the ciliary processes by cyclodiode therapy adjacent to an area of infiltration of the root of the iris and trabecular meshwork by densely pigmented cells (periodic acid Schiff, original magnification, ×100).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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