Kong Alan W, Au Adrian, Song Weilin, Oh Angela J, McCannel Tara A
Department of Ophthalmology, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, USA.
Clin Ophthalmol. 2024 Oct 16;18:2907-2915. doi: 10.2147/OPTH.S440072. eCollection 2024.
Distinguishing an iris melanoma from an iris nevus can be challenging as few clinical features other than documented growth are helpful in making the diagnosis. In this study, we compared the presenting intraocular pressure (IOP) and cup-to-disc ratio (CDR) between affected and unaffected eyes in patients with iris melanoma and iris nevus.
This was a single-institution retrospective case series of patients treated for iris melanoma and iris nevus from January 2013 to October 2022. Thirty-nine subjects with iris melanoma and forty age-matched patients with iris nevus were included. We analyzed the difference in IOP, CDR, and diagnosis of glaucoma between affected and unaffected eyes in patients with iris melanoma and control iris nevus cohort.
The average IOP for eyes with iris melanoma and iris nevus was 18.8±6.1 mmHg and 14.6±3.5 mmHg (P<0.001), respectively. The average CDR was 0.36±0.27 and 0.24±0.14 (P=0.02), respectively. The average IOP of the contralateral unaffected eye in iris melanoma patients was 16.3±3.5 mmHg, significantly less than the affected eye (P=0.03). The average CDR of the contralateral unaffected eye in iris melanoma was 0.25±0.15, which was trending towards being less than the affected eye (P=0.05). There was no difference in the average IOP (P=0.89) or average CDR (P=0.49) between the affected and unaffected eye in patients with iris nevus.
We demonstrate that patients with iris melanoma are more likely to have greater IOP and CDR in the affected eye compared to the unaffected eye, and a diagnosis of unilateral glaucoma than eyes with iris nevus. Patients with iris melanoma had greater IOP asymmetry between the affected and unaffected eye. Therefore, IOP and CDR asymmetry may suggest a diagnosis of iris melanoma.
鉴别虹膜黑色素瘤和虹膜痣具有挑战性，因为除了记录到的生长情况外，几乎没有其他临床特征有助于做出诊断。在本研究中，我们比较了虹膜黑色素瘤和虹膜痣患者患眼与未患眼的初始眼压（IOP）和杯盘比（CDR）。
这是一项单机构回顾性病例系列研究，纳入了2013年1月至2022年10月期间接受虹膜黑色素瘤和虹膜痣治疗的患者。包括39例虹膜黑色素瘤患者和40例年龄匹配的虹膜痣患者。我们分析了虹膜黑色素瘤患者和对照虹膜痣队列中患眼与未患眼在眼压、杯盘比及青光眼诊断方面的差异。
虹膜黑色素瘤患眼和虹膜痣患眼的平均眼压分别为18.8±6.1 mmHg和14.6±3.5 mmHg（P<0.001）。平均杯盘比分别为0.36±0.27和0.24±0.14（P=0.02）。虹膜黑色素瘤患者对侧未患眼的平均眼压为16.3±3.5 mmHg，显著低于患眼（P=0.03）。虹膜黑色素瘤对侧未患眼的平均杯盘比为0.25±0.15，有低于患眼的趋势（P=0.05）。虹膜痣患者患眼与未患眼的平均眼压（P=0.89）或平均杯盘比（P=0.49）无差异。
我们证明，与未患眼相比，虹膜黑色素瘤患者患眼更有可能出现更高的眼压和杯盘比，且比虹膜痣患者更易被诊断为单侧青光眼。虹膜黑色素瘤患者患眼与未患眼之间的眼压不对称性更大。因此，眼压和杯盘比不对称可能提示虹膜黑色素瘤的诊断。
