Gonzalez Martinez Orlando G, Shields Carol L, Shields Jerry A, Chévez-Barrios Patricia, Walley Debbie Rigney, Eagle Ralph C, Milman Tatyana
Department of Pathology, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
Department of Ocular Oncology Service, Wills Eye Hospital, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
Am J Ophthalmol Case Rep. 2023 Aug 19;32:101912. doi: 10.1016/j.ajoc.2023.101912. eCollection 2023 Dec.
To report a patient with a unilateral presentation of glaucoma, pain, and acute iris transillumination syndrome simulating iris melanoma.
A 53-year-old male presented with blurred vision and pain in his right eye several weeks following a respiratory sinus infection managed by oral azithromycin. Examination of the right eye was notable for elevated intraocular pressure of 46 mm Hg, an irregular mid-dilated pupil, and diffuse iris transillumination with pigmentary seeding on the iris surface, in the anterior chamber angle, and on the sclera, suspicious for diffuse iris melanoma with glaucoma and extrascleral extension. Ultrasound biomicroscopy (UBM) of the right eye revealed circumferential anterior chamber angle and trabecular meshwork involvement by an infiltrative process corresponding to the pigmented cells noted clinically, while the ciliary body was unremarkable. Following enucleation, histopathology showed extensive necrosis of the iris pigment epithelium, sphincter, and dilator muscles with melanophagic infiltration in the anterior chamber angle and episclera, mild chronic non-granulomatous iridocyclitis, and no evidence of a melanocytic neoplasm. Although immunohistochemical studies for herpes simplex virus (HSV) types 1 and 2, varicella-zoster virus, and cytomegalovirus were negative, qualitative real-time polymerase chain reaction on paraffin-embedded tissue detected HSV-1 DNA. The combined clinical, pathologic, and molecular findings were compatible with unilateral acute iris transillumination syndrome, likely HSV-1 associated.
Unilateral acute iris transillumination syndrome with diffuse iris pigment epithelial loss can simulate iris melanoma. Prompt herpes viral studies may be informative.
报告1例表现为单侧青光眼、疼痛及急性虹膜透照综合征，酷似虹膜黑色素瘤的患者。
一名53岁男性在口服阿奇霉素治疗呼吸道鼻窦感染数周后，出现右眼视力模糊和疼痛。右眼检查发现眼压升高至46 mmHg，瞳孔中度散大且不规则，虹膜弥漫性透照，虹膜表面、前房角和巩膜有色素沉着，怀疑为伴有青光眼和巩膜外扩展的弥漫性虹膜黑色素瘤。右眼超声生物显微镜检查（UBM）显示，与临床所见色素细胞相对应的浸润性病变累及前房角圆周和小梁网，而睫状体未见异常。眼球摘除术后，组织病理学显示虹膜色素上皮、括约肌和开大肌广泛坏死，前房角和巩膜外层有噬黑素细胞浸润，轻度慢性非肉芽肿性虹膜睫状体炎，无黑素细胞肿瘤证据。虽然1型和2型单纯疱疹病毒（HSV）、水痘带状疱疹病毒和巨细胞病毒的免疫组织化学研究均为阴性，但石蜡包埋组织的定性实时聚合酶链反应检测到HSV-1 DNA。综合临床、病理和分子学结果，符合单侧急性虹膜透照综合征，可能与HSV-1相关。
伴有弥漫性虹膜色素上皮缺失的单侧急性虹膜透照综合征可酷似虹膜黑色素瘤。及时进行疱疹病毒研究可能会提供有用信息。
