Melanocytomalytic glaucoma in eyes with necrotic iris melanocytoma

Iris melanocytoma, although histologically benign, may undergo spontaneous necrosis with the resultant pigment dispersion causing secondary open-angle glaucoma. The authors describe the clinical findings in three patients with this syndrome and review the current literature.

The study design was a small case series.

Three patients with secondary glaucoma caused by a necrotic iris melanocytoma participated.

Clinical records and pathologic preparations were reviewed. The diagnosis of iris melanocytoma was confirmed by histopathologic examination in all three cases.

All patients had intrinsically pigmented localized iris tumors and pigmentation of the angle. Hyperchromic heterochromia iridum was noticeable in all patients. In two instances, a central crater in the lesion signified tumor necrosis. Two patients were treated successfully by surgical resection of the iris tumor and the glaucoma resolved. One patient was treated with enucleation. In all patients, histopathologic analysis disclosed extensively necrotic tumor comprised of maximally pigmented nevus cells with bland nuclei and infiltration of the trabecular meshwork by melanophages.

Secondary glaucoma may result from obstruction of the trabecular meshwork with necrotic iris melanocytoma. Resection of the tumor may relieve the glaucoma.