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JAMA Ophthalmology Clinical Challenge
July 2017

Pigmented Iridociliary Lesion and Increased Intraocular Pressure

Author Affiliations
  • 1Alpert Medical School, Brown University, Providence, Rhode Island
  • 2Department of Ophthalmology, Duke University, Durham, North Carolina
  • 3Byers Eye Institute, Stanford University, Palo Alto, California
JAMA Ophthalmol. 2017;135(7):805-806. doi:10.1001/jamaophthalmol.2016.5128

A woman in her 70s with a history of cutaneous melanoma presented with a 10-week history of right-sided eye ache. Visual acuity was 20/25 OD, and intraocular pressure was 39 mm Hg OD. A pigmented iris lesion was noted, spanning from the pupillary margin to the anterior chamber angle, with several satellite lesions (Figure 1A). Gonioscopy showed a pigmented mass infiltrating the anterior chamber angle from the 2-o’clock position to the 5-o’clock position, with extensive pigmentation of the remaining angle structures. Anterior segment optical coherence tomography demonstrated a hyperreflective lesion invading into the anterior chamber angle. Ultrasound biomicroscopy revealed a mid-low reflective anterior ciliochoroidal lesion measuring 4.4 mm in height and 14.5 × 9.1 mm in largest basal dimensions, centered in the nasal quadrant and extending circumferentially from the 12-o’clock position to the 7-o’clock position (Figure 1B). Examination of the posterior pole and of the fellow eye was unremarkable. Contrasted computed tomography scans of the chest, abdomen, and pelvis were performed, along with baseline liver enzymes, which revealed no evidence of metastatic disease.