Lack of association between iris color and primary iris cysts

A case-control study of 78 white patients with primary cysts of the iris was undertaken. Two control groups were established for comparison with the subjects. Contingency tables were used to evaluate the distribution of iris color among subjects and controls. Statistical testing (chi 2) indicated no significant association of iris color with the presence of a primary iris cyst (P greater than .05). These results indicated that primary iris cysts do not exhibit the association with light iris color previously documented for iris melanocytic lesions.     

Diffuse melanocytic nevus of the iris and absolute glaucoma

BACKGROUND: Ferry et al. (8) showed that 35 % of eyes which have been enucleated because of a clinically suspected malignant iris lesion did not reveal a histologically malignant iris tumor. PATIENT: A 43-year old male presented with a blind, painful left eye, which has developed over a time period of 6 months. Ophthalmologic examination revealed the presence of pigmented iris stromal lesions associated with diffuse pigmentation of the chamber angle and the development of absolute glaucoma. A diffuse iridociliary malignant melanoma (ring melanoma) was suspected and the blind painful eye was enucleated. Histologic examination revealed the presence of a benign melanocytic lesion, i.e. a spindle cell nevus of the iris with surface plaques causing diffuse extension of the chamber angle, trabecular meshwork, Schlemm's canal, and the ciliary body. CONCLUSION: The malignant potential of iris lesions may be difficult to assess on clinical grounds only. Histologically, benign melanocytic proliferation may cause diffuse extension into the ciliary body as well as the chamber angle leading to an increase in intraocular pressure. In order to reach a final diagnosis a biopsy of the lesion is necessary.     

Latanoprost-induced iris color darkening: a case report with long-term follow-up

PURPOSE: To determine the effect on iris color of discontinuing latanoprost (LP) treatment in a patient with pronounced iris color darkening, and to assess the possible role of sympathetic innervation. METHODS: In a patient demonstrating pronounced iris color darkening in both eyes after treatment with LP for 6 months, magnified iris color photographs were taken at 3- to 6-month intervals for 5 years after discontinuation of LP treatment. Pupillary testing for sympathetic insufficiency was performed with cocaine 10% or hydroxyamphetamine 1%. RESULTS: The iris color did not appreciably change after discontinuing LP. The cocaine-induced increase in pupillary diameter was considerably greater for the control subject than for the patient who demonstrated the LP-induced color change. CONCLUSIONS: Latanoprost-induced iris color darkening does not appreciably change for several years after discontinuing treatment. Some eyes that show LP-induced darkening may have relative ocular sympathetic insufficiency.     

Melanoma of the iris and pregnancy

Iris melanoma is a malignant melanocytic tumor, making up 1.2%-6.6% of uveal malignant melanomas. The growth of choroidal melanoma during pregnancy is described and a hormonal influence is suggested. We present a case of iris melanoma occurring during pregnancy. A 32-year-old woman, in the 28(th) week of her fifth pregnancy, was referred to the ophthalmologist with a 2-month history of blurred vision and pain in her left eye. The visual symptoms became progressively worse with decreasing vision. Her visual acuity was 20/70 in her left eye, with a temporal, pigmented, prominent iris mass extending into the trabecular meshwork and the corneal endothelium. Elsewhere other pigmented localizations were found in the iris and in the trabecular meshwork. There was secondary glaucoma with intraocular pressure of 36mmHg and C/D=0.9. The right eye was normal. A general physical examination found no pigmented lesions. Chest radiography and hepatic ultrasonography revealed no metastasis. The diagnosis of iris malignant melanoma was made from the diffuse involvement extending into the trabecular meshwork and the advanced secondary glaucoma; an enucleation was performed and histopathological examination confirmed the diagnosis of iris melanoma with involvement of the trabecular meshwork. The patient had no further problems (follow-up of 11 months). From this case report, we discuss the differential diagnosis of iris melanoma and the hormonal influence on its growth.     

The iris after prostanoid treatment

Morphologic studies to date show that prostanoid-induced iris color change is not associated with any major pathologic process in the tissue. There is no evidence of melanocyte proliferation. The most likely mechanism for iris color darkening is increased melanogenesis, but this is not so marked as to cause any extensive release of melanin granules that might cause iris inflammation or even a pigmentary-type of glaucoma. Some patients, but not all, with color darkening have an apparent thickening of the anterior border zone; it remains to be established whether this is true thickening or merely if the anterior border is emphasized because of increased pigmentation.     

Nucleolar organizer regions in iris nevi and melanomas.

The silver staining of nucleolar organizer region-associated proteins is an objective method that has been used to differentiate benign from malignant neoplasms. Recently this method was used to distinguish benign choroidal nevi from malignant choroidal melanomas. We studied 24 iris melanocytic lesions to assess the applicability of this technique for differentiating benign from neoplastic iris tumors. Masked observers determined the number of silver-stained nucleolar organizer region dots per cell for silver-stained specimens. Iris nevi contained a mean of 1.6 silver-stained nucleolar organizer region dots per cell, whereas iris (spindle A and B, spindle B, epithelioid, mixed cell) malignant melanomas contained a mean of at least 3.5 silver-stained nucleolar organizer region dots per cell (P less than .0001). All iris nevi demonstrated counts lower than 1.9, whereas all iris melanomas demonstrated counts greater than 2.8. Silver-stained nucleolar organizer region counts were also compared with the clinicopathologic variables of gender, age, and largest specimen dimension. Only the largest specimen dimension correlated with silver-stained nucleolar organizer region counts (P less than .0029). The silver-stained nucleolar organizer region method is a simple technique for differentiating iris nevi from iris melanomas. The silver-stained nucleolar organizer region technique may aid in the assessment and treatment of iris lesions by confirming the malignancy of biopsy specimens.     

Evaluation of an iris color classification system. The Eye Disorders Case-Control Study Group

A system for classification of iris color based on standard photographs, developed for use in a multicenter study, is described. Categories of iris color are distinguished based on predominant color (blue, gray, green, light brown, or brown) and the amount of brown or yellow pigment present in the iris. Two trained readers independently graded 339 iris photographs; discrepancies in grades were adjudicated. Measures of interobserver reliability were 0.76 by kappa for exact agreement and 0.97 for weighted kappa. The distribution of iris color grades demonstrates that the system achieved an appropriate level of detail within the authors' study population, which included patients with various racial backgrounds from five urban clinical centers. This simple, reliable classification system for iris color is offered for use in clinical research.     

曲伏前列腺素滴眼液对虹膜颜色改变的影响

目的观察应用曲伏前列腺素滴眼液后虹膜颜色的改变。方法采用前瞻性、观察者单盲和对照性研究的设计方法进行临床试验研究。选取北京大学眼科中心确诊为原发性开角型青光眼（POAG）的患者37例73眼为用药组,患眼每晚睡前点质量分数0.004%曲伏前列腺素滴眼液1次,共30 d。健康志愿者21例42眼为对照组,不点任何滴眼液。2组虹膜均为纯棕色。用药组和对照组受试者于试验前后分别进行裂隙灯虹膜照相,对虹膜颜色是否加深进行评估,结果判断为加深、不确定、无变化,并应用计算机颜色分析软件对2组虹膜颜色数值变化进行量化比较分析。结果肉眼观察发现,用药组患者26眼（35.6%）用药后虹膜颜色加深,对照组颜色无改变,用药组虹膜颜色加深和不确定的眼数与对照组比较,差异有统计学意义（χ2=21.467,P=0.000）。用药组用药后肉眼和计算机软件判断均为虹膜颜色加深者共17眼（23.3%）,计算机软件分析结果显示用药组共22眼虹膜颜色加深（30.1%）,仅肉眼判断为虹膜颜色加深者26眼（35.6%）。结论在应用曲伏前列腺素滴眼液3个月后,约1/3的纯棕色虹膜患眼虹膜颜色加深。     

Complications of cosmetic iris implants

Cosmetic intraocular iris implants for the purpose of changing iris color have recently been developed; however, little is known about their safety. We report a patient who had bilateral implantation of colored silicone iris implants solely for cosmetic reasons. The rapid development of uveitis, corneal decompensation, and ocular hypertension resulted in the need for explantation of the implants. Placement of these devices should require specific medical indications and meticulous surgery with early and long-term evaluation.     

Measurement of iris color using computerized image analysis

PURPOSE: To develop a standardized method for measuring from iris photographs, light and dark segments of areas and densities of iris color. METHODS: Computerized image analysis was used to measure the iris photographs. The reproducibility of this method was studied in 30 normal eyes with three different colored irides, green-brown, blue-grey brown and yellow-brown. Three photographs were taken of each iris with a slit lamp camera at three different exposures at baseline. The photographs were repeated with exposure providing for the best reproducibility at 6.5 +/- 1.7 months as a first follow-up after baseline and 3.6 +/- 0.8 months following the first follow-up visit. At least one measurement was made for each photograph. RESULTS: The mean percent coefficient of variation (standard deviation of triplicate measurements/mean x 100) ranged from 1.0 to 4.1% for area and density measurements. Furthermore, the range of mean percent differences between baseline and follow-up visits ranged from 1.2 to 6.3%. CONCLUSION: We have developed a standardized method which appears suitable for measuring changes over time in iris color.     

Melanocytic lesions of the iris — A clinocopathological study of 100 cases

Between 1958 and 1985 (28 years), 100 melanocytic lesions of the iris were submitted to the Pathology Department of the Royal Victorian Eye and Ear Hospital (RVEEH). A clinicopathological correlation of these cases was performed. The mean age at presentation was 42.6 years (range 12 to 79 years). The average duration of a visible lesion prior to surgery was 5.7 years (range two weeks to 47 years). Most patients presented with an iris tumour with or without, a recent increase in size. Less frequent presentations were: pupil abnormalities, visual disturbances, raised intraocular pressure, iridocylitis, ‘cyst’ formation and hyphaema. Angle involvement was noted in 36 patients, either clinically or pathologically. The cases were morphologically classified as melanocytic naevi (9%0), low-grade malignant melanoma (79%), and highgrade malignant melanoma (1 2%). Detailed followup was obtained for 51 patients. Follow-up ranged from one to 27 years and was greater than five years in 35 patients. There were six recurrences (1 1.8%) and two patients developed metastases (3.9%). Five of the recurrences were classified as low-grade malignant melanoma. The two metastases and the other recurrences were from the high-grade malignant melanoma category.     

Light stimulation of iris tyrosinase in vivo

Although exposure of epidermal melanocytes to ultraviolet radiation is known to increase tyrosinace activity, a similar effect has never been demonstrated for the iris. This paper presents evidence that light stimulates tyrosinase activity in iris melanocytes in rabbits. Levels of iris tyrosinase were found to be greater in eyes of rabbits exposed to light for 6 weeks than in eyes of rabbits maintained in darkness. Despite increasing tyrosinase levels, exposure to light produced to no clinically observable change in iris color.     

Clinical and histopathologic findings of iris nevus (Cogan-Reese) syndrome.

PURPOSE: To report a case of Cogan-Reese syndrome. METHOD: Case report. A 37-year-old man presented with Cogan-Reese syndrome. RESULTS: Visual acuity was 0.5 in the right eye and 1.0 in the left eye. There were corneal edema and pigmented nodules on the anterior surface of the iris, iris atrophy and ectropion uvea in the right eye. The intraocular pressure was 42 mmHg in the right eye and there was glaucomatous optic atrophy of the optic disk. Trabeculectomy with mitomycin C has been performed as the intraocular pressure did not decrease with the maximum medical treatment. Electron microscopic examination of the trabeculum and the iris tissue revealed a lot of melanocytic cells in the stroma. CONCLUSION: Trabeculectomy with mitomycin C might be effective in Cogan-Reese cases with glaucoma resistant to medical treatment.     

Relative contraindication of latanoprost in iris tumors with secondary glaucoma

INTRODUCTION: Melanocytic iris tumors are often benign and merely require regular follow-up. Evident growth, increasing pigmentation and secondary glaucoma, however, are possible signs of a malignant transformation. PATIENT: We present a 34-year-old male patient showing a localized, mildly prominent hyperpigmentation of the right iris expanding over 2 h. The lesion had been known since childhood and increasing intraocular pressure (IOP) was treated with timolole, dipivefrin and finally with latanoprost. PROGRESSION: The patient was seen for the first time at our hospital 4 years previously, presenting an IOP of 28-30 mmHg of the right eye. The tumor had developed marked heterochromia and a nodular prominent surface, the chamber angle was partly closed and completely hyperpigmented. The ciliary body was not affected by the tumor and standard ultrasound revealed a maximum thickness of 1.2 mm. Over the last 4 years, IOP and heterochromia had increased but without growth of the tumor. An excisional biopsy of the prominent portion was refused by the patient. DISCUSSION: The melanocytic iris tumor described shows malignant characteristics such as progressive heterochromia and secondary glaucoma. However, increasing iris pigmentation can also be caused by topical application of latanoprost. With the evidence of absent tumor growth, there is no reason to suggest malignant degeneration. Generally, in iris naevi or tumors requiring regular follow-up, application of latanoprost should be avoided in order not to conceal the alteration of pigmentation as possible malignant conversion.     

Increased iris pigmentation after use of latanoprost in Japanese brown eyes

PURPOSE: To evaluate the incidence of the increased iris pigmentation in Japanese with topical latanoprost. MATERIAL AND METHODS: One hundred and twelve patients who had homogeneous brown irises were studied. Age of the patients was 23 to 80(average 63.8 +/- 10.4) and follow-up periods were 6 to 12 (10.3 +/- 1.4) months. Slit lamp examination was carefully performed before use and at every month after use of latanoprost. Photographs were taken when necessary. The Kaplan-Meier life table method was used to evaluate the incidence of the increased iris pigmentation. RESULT: Iris pigment increase was observed in 47 patients. The incidence of the increased iris pigmentation was calculated as 10.1% at 3 months, 26.4% at 6 months, 50.1% at 9 months and 51.6% at 12 months after use. Pigmentation progressed as a granular concentric or sunrise pattern or a subtype of these. Some pigmentation occurred at one month after use, and progressed monthly. No patients noted their own iris color change, but were told by their relatives. Iris color changes of brown iris were considered to be less strong than in the hazel(green or blue/gray or yellow combined with brown) eye.     

Bilateral acute depigmentation of the iris

Purpose To report on five cases of unusual bilateral stromal depigmentation of the iris and pigment dispersion masquerading as uveitis.Methods We describe the clinical features of five consecutive patients who presented with acute depigmentation of the iris stroma between June and October 2003.Results Four patients were female, one was male. Age at presentation ranged from 15 to 25 years. Presenting symptoms were sudden-onset ocular discomfort and red eye in four patients and change of eye color in one patient. All patients had bilateral involvement, with a symmetrical diffuse depigmentation of the iris stroma in three cases and patchy areas of iris depigmentation in two. Other common features were mild ciliary injection (seven eyes), Krukenberg spindle (seven eyes), circulating pigment in the anterior chamber (eight eyes), and heavy pigment deposition in the angle (ten eyes). No eyes had iris transillumination defects, inflammatory keratic precipitates or inflammatory cells in the anterior chamber. Systemic laboratory work-up was unrewarding in all cases, and PCR analysis of the aqueous humor for HSV1 and 2 was negative in one patient. Four patients were treated with a short course of topical corticosteroids and three with oral acyclovir. One patient was lost to follow-up. The remaining four patients were followed up for 6–19 months with a stable clinical picture.Conclusion In contrast to pigment dispersion syndrome, pigment seemed to be released from iris stroma in the five cases described here. Although patchy depigmentation of the iris resembled the lesions seen in herpetic iridocyclitis in two of the patients, symmetrical bilateral involvement and lack of intraocular inflammation were the differentiating features. The patients described here could represent a new entity or an unusual presentation of herpetic eye disease.Presented at the American Uveitis Society Meeting, Ft. Lauderdale, Florida, 24 April 2004.     

Unoprostone isopropyl ester darkens iris color in pigmented rabbits with sympathetic denervation

PURPOSE: Unoprostone isopropyl ester (unoprostone) -induced iris color darkening was evaluated in a rabbit model using a cyclooxygenase inhibitor, an alpha(1)-adrenergic antagonist, and sympathetic denervation. MATERIALS AND METHODS: Dutch-belted rabbits were divided into five groups based on type of surgery and eyedrop treatment to both eyes: (1) sham surgery (n = 7); (2) bilateral superior cervical ganglionectomy (SCGx, n = 7); (3) SCGx plus flurbiprofen 0.03% (n = 7); (4) SCGx plus thymoxamine 0.5% (n = 6); and (5) SCGx plus flurbiprofen and thymoxamine (n = 6). All rabbits were treated with unoprostone 0.12% to one eye and its vehicle to the contralateral eye twice daily for 43 weeks after SCGx. Periodic color photographs of paired eyes were scored for difference in eye color. Iris melanin and aqueous humor protein were measured at week 43. RESULTS: Twenty-three of the 26 rabbits with bilateral SCGx and unilateral unoprostone treatment demonstrated a darker iris color on the unoprostone-treated side. The average scores (demonstrating difference in iris color) comparing photographs of treated versus control eyes in the four SCGx groups were higher than those in the sham surgery group (P < 0.03), and higher than at week 0 (P < 0.001). The group pretreated with flurbiprofen and thymoxamine had the highest score of all groups. The aqueous humor protein in unoprostone-treated eyes was higher (P < or = 0.0001) than in vehicle-treated eyes. The melanin content of irides of the denervated groups was higher (P < or = 0.01) in unoprostone-treated than in vehicle-treated eyes. CONCLUSION: Unoprostone produced iris color darkening in pigmented rabbit eyes with sympathetic denervation. Pretreatment with flurbiprofen and thymoxamine appeared to enhance this effect but this was not statistically demonstrated by the study.     

The influence of iris color on the pupillary light reflex

· Background: This study was carried out to investigate the effect of iris color on the pupillary light reflex (PLR) in normal healthy volunteers. · Methods: Pupil perimetry was performed on 50 healthy volunteers with the Octopus 1-2-3 automated perimeter. Within the 30-deg visual field, 33 test locations were investigated four times. Stimulus parameters were Goldmann size V (1.72°), intensity 1632 cd/m², stimulus time 200 ms, background illumination 0 cd/m², and interstimulus interval 3 s. Pupillometric parameters studied were initial pupil size, amplitude (magnitude of pupillary contraction), latency time, contraction time, pre-PLR movement, contraction velocity, and redilation velocity. Pupillometric parameters were investigated by analysis of variance by the independent variables blue and brown irides. · Results: Iris color (blue vs brown) influenced statistically significantly (P<0.05) amplitude (0.504 mm vs 0.594 mm), contraction time (401 ms vs 407 ms), contraction velocity (13.75 mm²/s vs 16.01 mm²/s), and redilation velocity (4.80 mm²/s vs 5.66 mm²/s). Iris color did not influence initial pupil size (4.78 mm vs 4.83 mm), latency time (520 ms vs 521 ms), and pre-PLR movement (0.328 mm²/s vs 0.325 mm²/s). · Conclusions: Pupillary contraction amplitude and velocity depended on iris color, whereas pupil size and latency time were independent of iris color. Therefore, iris color might be considered when evaluating pupillary movements in pupil perimetry. Received: 2 July 1997 Revised version received: 1 December 1997 Accepted: 9 December 1997     

The relationship among race, iris color, central corneal thickness, and intraocular pressure.

PURPOSE: Central corneal thickness (CCT) influences applanation intraocular pressure (IOP) measurement. The present study sought to determine whether iris color might represent a qualitative surrogate for CCT or race, and therefore differential risk for elevated IOP and, consequently, developing glaucoma. METHODS: Eligible patients included those with best-corrected visual acuity (BCVA) better than 20/40 and who had not worn contact lenses within 24 hours. Exclusion criteria were prior ophthalmic surgery, topical ocular or systemic medication that would influence IOP, previous ocular inflammatory conditions, or current treatment for ophthalmic treatment. Data collection included demographic (name, date of birth, race), BCVA, and iris color. Iris color was judged according to a purpose-developed chart (white: blue, green, brown or black: brown) and patients were assigned to one of four groups. Goldmann applanation tonometry and pachymetry measurements were performed consecutively. To attain a power of 90% to find a difference of 40 microm with alpha < 0.05, we examined at least 14 subjects (28 eyes) for each group. RESULTS: Comparing pachymetry measurements among iris colors revealed no statistically significant difference among the three groups of whites: blue (552 microm), green (552 microm), and brown (562 microm). The same held true when comparing IOP and CCT-adjusted IOP with iris color: blue-15.2, 15.1, green-15.4, 15.2, and brown-14.7, 14.0. When comparing CCT between whites and blacks, CCT was significantly thinner in blacks (533 microm), whether evaluating all whites (555 microm, p = 0.03) or comparing only the brown-iris white group with the black group (562 microm vs. 533 microm, p = 0.03). Mean CCT-adjusted IOP was barely significantly different between whites (14.8) and blacks (16.7) (p = 0.04). CONCLUSION: These results suggest that iris color is not associated with CCT and apparently iris color does not influence measured IOP. We were able to establish a relationship between race and IOP when adjusting IOP for CCT. Our data show a significantly higher CCT-adjusted IOP for blacks than whites demonstrating a racial difference in CCT-corrected IOP.