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Enoch Kassa, Yang Sun; Prognostic relevance of elevated intra-ocular pressure in ocular melanoma. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3634.
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Uveal melanoma is the most common primary intraocular malignancy. Uveal melanoma which can be divided into anterior and posterior segment represents around 5% of all malignant melanomas. The anterior segment melanomas arise from the Iris and cilia. These malignancies have been commonly but variably associated with an increased prevalence in tumor associated glaucoma. Glaucoma represents an unfavorable prognosis. Moreover, there is a strong correlation between glaucoma and metastases. This study investigates the correlation between glaucoma and prognosis of anterior segment uveal melanoma.
This was a retrospective chart review of 35 anterior segment uveal melanomas. The record of these patients was followed through the entirety of the management. Demographics, intraocular pressures and the location of the tumor of all the patient was recorded. After tissue analysis reports, the mechanism of intraocular pressure was identified. Finally, the prognostic relevance of an elevated IOP was illustrated on a Kaplan-Meier survival plot.
97% of the patients were white. 42% were male. 8 (23%) had an elevated IOP (defined as greater than 30 mmHg). The most common cause of elevated IOP was diffuse lesions (11%). 6 (75%) from the group categorized as “elevated IOP” underwent enucleation and 1 (12.5%) died.
This study supports the hypothesis that glaucoma associated with anterior segment uveal melanoma carries a poor prognosis. 87.5% of patients with elevated IOP had bad outcomes.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
Distribution of iris melanoma. Percentages correspond to the respective location of the diagnosed uveal melanoma. Note, the 11% corresponds to a “ring melanoma”.
A 38 year old Caucasian female presented with a pigmented iris lesion of the right eye, with elevated IOP of 33 on timolol and brimonidine (A). UBM showed a solid mass in the infranasal quadrant (B). Upon enucleation, pathology showed a large ciliary body melanoma with pigmented cells dispersed in the angles of the anterior chamber (C-E). High power field showed epithelioid cell type with mitotic figures (F).
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