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Y. Sun, G. Comer, M. Roh, S. E. Moroi; Is Elevated Intraocular Pressure a Prognostic Sign for Metastasis of Iris and Ciliary Body Melanomas?. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5153.
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Iris and ciliary body melanomas comprise a small fraction of uveal melanomas. The relationship between these anterior segment melanomas and intraocular pressure (IOP) has not been well characterized. Our purpose was to evaluate whether or not elevated IOP in iris and ciliary body melanomas is associated with an increased the rate of metastases and death.
An IRB approved retrospective study was performed. Using ICD-9CM billing codes, data from all clinical visits during 1996-2009 were reviewed to identify individuals who were diagnosed with iris and/or ciliary body melanoma. Histopathologic diagnosis of melanoma was required for inclusion into the study. Choroidal metastases and pigmented lesions without pathologic diagnoses were excluded from the study. Elevated IOP was defined as greater than 30 mmHg and/or treated with IOP medications prior to surgical intervention.
Twenty-eight patients with histopathologic diagnoses of iris and/or ciliary body melanoma were identified. The average age was 51 +/- 22 years with 8.1 years of follow-up. Twenty-one patients had circumscribed iris and/or ciliary body melanoma, only one had elevated IOP, and two died with metastasis. Seven patients had diffuse iris and/or ciliary body melanoma. Six of seven patients had elevated IOP and three died with metastases to liver and brain. On histopathology, six of seven diffuse tumors had angle invasion. Kaplan-Meier survival curves over 24 years showed the survival rates for both iris and ciliary body melanoma to be 77%; circumscribed iris and ciliary body melanoma, 94%; and diffuse iris and/or ciliary body melanoma, 33%.
Based upon our case series, both circumscribed iris and ciliary body melanomas are less likely to have elevated IOP and appear to have lower chance of developing metastases. Diffuse iris melanoma is aggressive and causes seeding of tumor cells into the trabecular meshwork, resulting in secondary glaucoma and elevated rates for metastases and death.
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