A case report: iridociliary melanocytoma associated with secondary glaucoma.

Abstract

Background: Distinguishing between benign iridociliary melanocytoma and malignant melanoma presents a diagnostic challenge, particularly given the potential overlap in tumor growth patterns and clinical manifestations, especially when patients present with secondary glaucoma. Misdiagnosis may induce severe clinical consequences, including enucleation. Therefore, the judicious selection of biopsy or surgical techniques is crucial in both diagnosing and managing the condition.

Case presentation: A 44-year-old female presented with uncontrolled elevated intraocular pressure (IOP) and a heavily pigmented iris lesion extending into the anterior chamber angle and adjacent ciliary body. Unexpectedly, standardized initial fine-needle aspiration biopsy (FNAB) yielded inconclusive results. Subsequent excisional surgery (partial iridocyclectomy and concurrent phacoemulsification) was performed to remove the tumor mass and treat cataract. Histopathological analysis confirmed the diagnosis as melanocytoma. Lens implantation followed upon normalization of IOP within 8 months. At the 2-year follow-up, the patient exhibited a satisfactory clinical outcome, with no tumor recurrence, achieving a best-corrected visual acuity of 20/40 and an intraocular pressure of 18.5 mmHg.

Conclusions: This case underscores the importance of obtaining adequate tumor specimens for accurate diagnosis via FNAB in iris and ciliary body tumors. Additionally, for patients with secondary glaucoma, partial iridocyclectomy emerges as a promising intervention, addressing anterior chamber angle obstruction to alleviate IOP while facilitating histopathological diagnosis for subsequent management.