Iris Varix: Report of a Case and Review of Iris Vascular Anomalies

Iris vascular anomalies are rare benign vascular tumors and simulating lesions of the iris stroma. These can be classified into five distinct, clinicopathological entities: iris capillary hemangioma, iris cavernous hemangioma, iris microhemangioma, iris arteriovenous malformation, and iris varix. We have reviewed all reported cases of iris hemangiomas since 1970, as prior cases have been extensively reviewed by Ferry. We also report a case of an iris varix, confirmed by histopathological and immunohistochemical examination. Comparative features of each subtype of vascular anomaly are discussed.     

The differential diagnosis of malignant melanoma of the iris. A clinical study of 200 patients

The records of 200 consecutive patients referred to the Ocular Oncology Service of Wills Eye Hospital because of an iris lesion suspected of being an iris melanoma were reviewed. On clinical evaluation, 24% of the lesions met the criteria for the diagnosis of iris melanoma and 76% were diagnosed as simulating lesions (pseudomelanomas). The most common pseudomelanomas included primary iris cyst (38%), iris nevus (31%), essential iris atrophy (5.7%), iris foreign body (4.5%), peripheral anterior synechia (2.5%), and iris metastasis (2.5%). Less frequently encountered pseudomelanomas included aphakic iris cysts, leiomyoma, melanocytoma, reactive lymphoid hyperplasia, adenoma of iris pigment epithelium, iridoschisis, and other miscellaneous entities. The clinical features that are helpful in differentiating the more common iris pseudomelanomas from true melanomas are discussed. Correct clinical identification of these simulating lesions may prevent unnecessary surgery or other treatment.     

Peripheral pigmentary iris cyst: evaluation and differential diagnosis

Peripheral iris pigment epithelial cysts are benign lesions of the anterior segment. They are located at the iridociliary junction and can produce a localised distortion and/or displacement of the iris. Patients who have these lesions are usually asymptomatic and in the absence of a careful slitlamp examination will often remain undetected. The aetiology of these cysts is unknown and they tend to be unilateral and solitary in nature. The cyst walls are composed of iris pigment epithelium and the lumen contains clear fluid. Women are three times more likely to develop these cysts, which must be differentiated from malignancies of the iris or ciliary body. We report a case involving a peripheral pigmentary iris cyst and discuss methods of differentiating this benign lesion from serious ocular tumours.     

Natural Course of Melanocytic Tumors of the Iris

The authors received the charts and photographs of 175 patients who had suspicious melanocytic lesions of the iris and who were followed without treatment. Only eight (4.6%) of these lesions showed clinical evidence of enlargement during follow-up intervals of 1 to 12 years (mean, 4.7 years). Features that were associated with enlargement of the lesion included medial location of the mass on the iris and presence of pigment dispersion onto the adjacent iris and anterior chamber angle structures. Features that were unassociated with growth of the lesion included patient age and sex, intraocular pressure, iris color, tumor size and vascularity, and presence of pupillary distortion, ectropion iridis, and sector cataract. From these results, recommendations are made which can assist the ophthalmologist in the management of pigmented iris lesions.     

Iridoschisis

Iridoschisis is a rare condition in which a localised area of iris stroma is cleaved in two with the anterior atrophic portion disintegrating into fibrils. The most common presentation of iridoschisis is as an age-related iris atrophy in association with glaucoma. The association includes angle-closure glaucoma, angle-recession glaucoma and open-angle glaucoma. A finding of iridoschisis is a warning to the clinician to assess the patient for pre-existing glaucoma and to monitor for glaucomatous changes as it is unclear if iridoschisis is a cause or an effect of raised intraocular pressure (IOP).     

虹膜缝针行上鞋式虹膜睫状体缝合术的临床研究

目的 探讨自行设计的虹膜缝针对虹膜、睫状体损伤行上鞋式缝合修复的手术效果．方法 对虹膜根部离断8眼，虹膜放射状撕裂或节段性缺损11眼，睫状体脱离5眼。在眼球密闭状态下使用虹膜缝针进行往复式连续缝合修复．观察其疗效。结果 19例虹膜损伤患者术后瞳孔基本居中、恢复圆形或椭圆形，5例睫状体脱离患者睫状体复位．眼压恢复正常。结论 虹膜缝针及上鞋式缝合术对虹膜、睫状体缝合修复具有创伤小、易操作．能重建虹膜、睫状体解剖关系的特点．具创新性和实用意义。     

Iris reconstruction combined with iris-claw intraocular lens implantation for the management of iris-lens injured patients

Aim:To study the efficiency and safety of iris reconstruction combined with iris-claw intraocular lens (IOL) implantation in the patients with iris-lens injuries.Results:Uncorrected VA (UCVA) in all injured eyes before combined surgery was equal to or <20/1000. Within a 1.1–4.2-year follow-up period, a significant increase, equal to or better than 20/66, in UCVA was observed in six (55%) cases, and in best-corrected VA (BCVA) was observed in nine (82%) cases. Postoperative BCVA was 20/40 or better in seven cases (64%). After combined surgery, the iris returned to its natural round shape or smaller pupil, and the iris-claw IOLs in the 11 eyes were well-positioned on the anterior surface of reconstructed iris. No complications occurred in those patients.Conclusions:Iris reconstruction combined with iris-claw IOL implantation is a safe and efficient procedure for an eye with iris-lens injury in the absence of capsular support.     

Biomicroscopy and fluorescein angiography of pigmented iris tumors

The classification of pigmented iris tumors is a difficult clinical problem. Based on the retrospective observation of colour photographs and iris angiograms of 44 pigmented iris tumors observed over 19 years, the authors present an original grading scheme with scores depending on both the biomicroscopical and the fluoroiridographic patterns of the tumors. The biomicroscopical parameters considered were: thickening of the iris in the area of tumor, pupillary distortion and/or ectropion uveae and uneven pigment density. The fluoroiridographic parameters were: early visibility of the anomalous tumoral network, hyperfluorescence inside or around the tumor, and dye leakage at sites remote from the mass. Based on the score of each tumor, the 44 cases were divided into 3 groups with the different degrees of malignancy confirmed by either histological examination or by follow-up behaviour. The authors suggest that routine use of biomicroscopic-fluoroiridographic classification of pigmented iris tumors would be useful.     

Familial Aortic Dissection and Congenital Iris Flocculi with Hypertension

Familial clusters of aortic dissection without connective tissue diseases are rare. We report a family with aortic dissection, congenital iris flocculi and hypertension in the young. This suggests that this combination of an uncommon familial phenotype may have a common etiology.     

虹膜色素颗粒对兔眼小梁切除术后滤过通道瘢痕化影响的实验研究

目的探讨虹膜色素上皮(iris pigment epithelium,IPE)层色素颗粒对兔眼小梁切除术后滤过通道瘢痕化过程及Tenon囊成纤维细胞增生的影响。设计实验研究。研究对象新西兰大白兔18只。方法单眼做小梁切除手术模型。实验组巩膜瓣下放置0.1 ml(100μg/ml)猪IPE层色素颗粒并保留,阳性对照组和阴性对照组分别放置0.4 mg/ml丝裂霉素C棉片和生理盐水棉片3分钟。术后观察眼压、滤过泡形态30天,并对滤过泡及其周边组织进行组织病理学检查。主要指标眼压、滤过泡形态、手术滤过区瘢痕化程度。结果实验组、阳性对照组、阴性对照组兔眼术前平均眼压分别为(24.78±1.40)、(24.11±1.18)、(24.00±1.53)mmHg(F=0.241,P=0.789)。术后30天平均眼压分别为(20.28±1.87)、(20.39±2.28)、(23.33±1.14)mmHg(F=22.500,P=0.000)。实验组与阳性对照组无显著差异(P=0.86),实验组与阳性对照组均低于阴性对照组(P均=0.000)。滤过泡平均存留时间分别为(28.17±1.72)、(27.00±2.37)、(10.67±1.97)天(F=138.592,P=0.000)。组织病理学检查示实验组和阳性对照组兔眼滤过区结构相似,胶原纤维和瘢痕组织相对较少,而阴性对照组胶原纤维和瘢痕组织明显增生。结论小样本量短期实验研究表明,IPE层色素颗粒可能阻止Tenon囊成纤维细胞增生过程,有助于延缓小梁切除术后滤过通道瘢痕化。     

Incidence,clinical findings and management of intraoperative floppy iris syndrome associated with tamsulosin

Purpose: To determine the risk ratios and incidence of intraoperative floppy iris syndrome (IFIS) during cataract surgery in patients using tamsulosin, and to assess management strategies for IFIS. Methods: We performed a non‐randomized, observational, prospective study, in which 594 eyes of 579 patients undergoing cataract surgery were enrolled. Surgeons were masked to the patients’ drug history. Usage or non‐usage of tamsulosin, duration of tamsulosin use, presence or absence of IFIS, management of IFIS and intraoperative complications were recorded in the patients’ theatre notes. Results: Twelve of 15 (80%) IFIS patients were taking systemic tamsulosin. Twelve of 23 (52%) patients using tamsulosin showed features of IFIS. The odds ratios (ORs) and relative risk (RR) ratios show strong positive correlations between tamsulosin use and IFIS. The ORs and RR ratios and the 95% confidence intervals (CIs) are as follows: OR 206.5 (95% CI 50.9–836.5); RR 99.3 (95% CI 30.0–327.8). There were no statistically significant differences between patients with or without IFIS, who were using tamsulosin, in terms of age or duration of tamsulosin use (p > 0.05). Seven eyes (46.6%) with IFIS were successfully managed with epinephrine. Eight eyes (53.4%) with IFIS needed iris hooks. Conclusions: Patients using tamsulosin appear to be at high risk of IFIS during cataract surgery. The occurrence of IFIS may not be affected by duration of tamsulosin use or age. Epinephrine may be effective in approximately 50% of eyes with IFIS. The iris hook procedure represents an effective management strategy in IFIS.     

Spontaneous intrastromal iris cyst. A case report with immunohistochemical and ultrastructural observations

A 39-year-old man had an enlarging intrastromal iris cyst that obstructed the chamber angle inferotemporally and abutted the cornea. No history of ocular trauma or previous surgery was present. Iridocyclectomy with en bloc resection of the cyst was performed. The cyst was lined by one to three cell layers of focally pigmented epithelium that ultrastructurally exhibited desmosomes, tonofilaments, terminal bars, and apical microvilli. Additionally, membrane-bound melanin granules (melanosomal complexes) consistent with phagocytized uveal melanin granules were observed. Immunohistochemistry confirmed intracellular keratin. We conclude that the non-traumatic cyst reported herein is of surface ectodermal origin and suggest that such cysts be removed en bloc by sector iridectomy or iridocyclectomy if the lesion has been proven to enlarge.     

Iris cysts: A comprehensive review on diagnosis and treatment

Iris cysts, both primary and secondary, are a diagnostic and treatment challenge. Primary cysts arise either from the iris pigment epithelium or the iris stroma. Posterior pigment epithelial cysts are subdivided according to their location as central, midzonal, and peripheral. Iris stromal cysts are classified either as congenital or acquired. Free-floating cysts are usually dislodged pigment epithelial cysts. Secondary cysts are classified according to the underlying cause as implantation cysts, drug-induced, uveitic, tumor-induced, parasitic, or as cysts associated with systemic disorders. Differential diagnosis is based on the clinical presentation and imaging. Ultrasound biomicroscopy is the gold standard for the imaging of iris cysts, combining excellent resolution with sufficient tissue penetration. Treatment of iris cysts depends largely on whether they become symptomatic or not. Symptoms include obstruction of the visual axis, corneal decompensation, secondary uveitis, and secondary glaucoma. Treatment options cover a range from simple observation to fine-needle aspiration (with or without intracystic injection of absolute alcohol or antimitotic agents), laser (argon, Nd:YAG), or surgical excision. In the past, the prevailing notion was that of a radical surgical intervention in the form of iridectomy or iridocyclectomy. Given the high rate of recurrence, a stepwise conservative approach is currently favored by most clinicians.     

虹膜缺损眼人工晶状体植入术

目的　探讨治疗先天性和外伤性虹膜缺损或同时伴有白内障的有效方法。方法　对眼外伤致虹膜缺损和先天性虹膜缺损患者 2 1例 2 3眼 ,采用白内障摘出术联合虹膜型人工晶状体囊袋内植入术或人工虹膜合并人工晶状体囊袋内植入术。结果　术后随访 3～ 18个月 ,平均 9.6个月 ,术后视力较术前视力提高 ,术后最佳矫正视力 >0 .5者 12眼( 5 2 .17% ) ,0 .1～ 0 .5者 9眼 ( 39.13% )。 2 2眼畏光消失 ,1眼畏光减轻。未发生严重并发症。结论　虹膜型人工晶状体囊袋内植入术或人工虹膜合并人工晶状体囊袋内植入术治疗虹膜全部缺失或虹膜部分缺损白内障或无晶状体眼安全、有效的方法     

Iris cysts in children: classification, incidence, and management. The 1998 Torrence A Makley Jr Lecture.

BACKGROUND: Iris cysts in children are uncommon and there is relatively little information on their classification, incidence, and management. METHODS: The records of all children under age 20 years who were diagnosed with iris cyst were reviewed and the types and incidence of iris cysts of childhood determined. Based on these observations recommendations were made regarding management of iris cysts in children. RESULTS: Of 57 iris cysts in children, 53 were primary and four were secondary. There were 44 primary cysts of the iris pigment epithelium, 34 of which were of the peripheral or iridociliary type, accounting for 59% of all childhood iris cysts. It was most commonly diagnosed in the teenage years, more common in girls (68%), was not recognised in infancy, remained stationary or regressed, and required no treatment. The five mid-zonal pigment epithelial cysts were diagnosed at a mean age of 14 years, were more common in boys (83%), remained stationary, and required no treatment. The pupillary type of pigment epithelial cyst was generally recognised in infancy and, despite involvement of the pupillary aperture, also required no treatment. There were nine cases of primary iris stromal cysts, accounting for 16% of all childhood iris cysts. This cyst was usually diagnosed in infancy, was generally progressive, and required treatment in eight of the nine cases, usually by aspiration and cryotherapy or surgical resection. Among the secondary iris cysts, two were post-traumatic epithelial ingrowth cysts and two were tumour induced cysts, one arising from an intraocular lacrimal gland choristoma and one adjacent to a peripheral iris naevus. CONCLUSIONS: Most iris cysts of childhood are primary pigment epithelial cysts and require no treatment. However, the iris stromal cyst, usually recognised in infancy, is generally an aggressive lesion that requires treatment by aspiration or surgical excision.     

瞳孔成形术在眼外伤修复术中的作用

目的 探讨瞳孔成形术在眼外伤修复术中的作用。方法 采用多种瞳孔成形技术联合其他眼科手术(如角膜修补术、人工晶状体植入术及玻璃体切除术等)治疗各种伴虹膜损伤的外伤43眼。随访3月-2年。结果 42眼术后视力较术前有不同程度的提高(z=-5．567，P=0．000)，无一眼出现单眼复视。所有病例术后瞳孑孔呈圆形或类圆形，瞳孑孔中央位40眼，瞳孔偏位3眼。术前伴继发青光眼5眼，术后眼压控制。术后前房积血3眼，玻璃体积血1眼，经保守治疗痊愈。人工晶状体光学部边缘暴露于瞳孔区1眼。结论 瞳孔成形术既能恢复虹膜的完整性，又能改善光学效果和美容效果，还能稳定眼内环境，在眼外伤修复中有重要作用。     

Iris cavernous hemangioma :a case report

 Purpose：Cavernous hemangioma of the iris is rarely seen, which can be presented with spontaneous hyphema. Methods: In this report, we described a case of an iris cavernous hemangioma treated surgically, and the histopathological findings were also presented. Results: Slitlamp biomicroscopy showed a lobulated, reddish-blue temporal iris mass. Anterior segment OCT presented a circumscribed mass of iris stroma at the papillary margin. Histopathologic examination revealed a benign tumor composed of large blood-filled vessels. Conclusion：The present case highlights the features of iris cavernous henagioma and demonstrates the histopathological findings.     

Action of biologically active peptides on monkey iris sphincter and dilator muscles

Biologically active peptides modulate pupillary responsiveness in many non-primate mammals. We examined the action of seven different peptides on iris sphincter and dilator muscles of rhesus monkey. Iris sphincter and dilator muscle preparations from rhesus monkeys were mounted in an organ bath, and tension changes were recorded by an isometric transducer. Electrical field stimulation (100Hz, 0.3 msec, 10V) was applied through a pair of platinum plate electrodes. Monkey iris sphincter and dilator muscles produced simple cholinergic and adrenergic excitatory responses respectively to electrical field stimulation. Strong field stimulation did not elicit slow Substance P (SP) mediated contractions like those in rabbit iris sphincter. Exogenously applied pituitary adenylate cyclase-activating peptide (PACAP) enhanced in a concentration-dependent manner (0.3 nM-0.1 microm) the sphincter response to field stimulation, while neuropeptide Y (NPY) and somatostatin (SRIF) attenuated it. These three peptides did not affect sphincter contractions induced by acetylcholine, and therefore were acting at presynaptically. SP, calcitonin gene-related peptide (CGRP), vasoactive intestinal polypeptide (VIP) and galanin (GAL) had no effect (at 0.1 microm) on iris sphincter. None of seven exogenously applied peptides had an effect on monkey iris dilator muscle. The innervation of primate irises may be relatively simple compared to non-primates because each of the peptides in this study can modulate miosis or mydriasis in non-primate mammals. Future studies will be expected on the functional significance of species differences in iridial innervation.