Ocular Oncology Cases from Cole

SEPTEMBER 2010 ADVANCED OCULAR CARE 31 CASE PRESENTATION A 76-year-old white man was referred to our clinic for evaluation of a pigmented lesion that recently increased in size. He had first noticed the abnormal iris pigmentation of his right eye 20 years ago and had been under observation for the previous 5 years. The patient denied any ocular or systemic symptoms; his past medical history was significant for cataracts in both eyes and hypertension. On examination, the patient’s visual acuity was 20/70 in the right eye and 20/60 in the left. The IOP was 20 mm Hg in both eyes. The eyelids and conjunctiva were normal bilaterally. Anterior segment examination of his left eye revealed map-dot-fingerprint dystrophy of the left corneal epithelium. The right eye was remarkable for corectopia and oval elongation of the pupil (Figure 1). There was evidence of pigmentary migration from the posterior margin of the iris, across the anterior surface, and into the nasal limbal cornea. The cornea appeared to be decompensated near the 3-o’clock limbus, corresponding to an area of calcium deposits. Peripheral anterior synechiae extended from the 2to the 5-o’clock position, with evidence of iridoschisis inferior nasally. A gonioscopic evaluation confirmed the presence of broad-based anterior synechiae (Figure 2). Vascularization of the iris or angle was absent. There was no evidence of an iris or ciliary body mass, either on clinical examination or by ultrasound biomicroscopy (Figure 3). The dilated fundus examination was normal in both eyes. The clinical findings were diagnostic of iridocorneal endothelial (ICE) syndrome.