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Eye tumors misdiagnosed as glaucoma.

Yang M, Wang W, Yan JH, Li XY, Zhou MW, Huang WB, Zhang XL - Chin. Med. J. (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Strabismus and Amblyopia, State Key Laboratory of Ophthalmology, Sun Yat sen University, Guangzhou, Guangdong 510060, China.

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They can be misdiagnosed as glaucoma because of red eye, pain, severe headache, elevated intraocular pressure (IOP), even adhesion of the angle of the anterior chamber... In a study by Shields et al., 58 in 144 (40%) of patients with iris melanoma were diagnosed as glaucoma on their initial visit... The total of 9 patients with eye tumors were misdiagnosed as glaucoma at their first visit... These patients included one case of choroid melanoma, one case of iris and ciliary body melanoma, one case of ciliary body medulloepithelioma, one case of intraocular metastases, one case of optic nerve sheath meningioma, and four cases of retinoblastoma... Then, a UBM [Figure 1i] was immediately conducted and found a 4.5 mm × 3.5 mm iris-ciliary body mass... On the other hand, a B-scan [Figure 1j] did not find an obvious mass... When he came to us, the diagnosis of secondary glaucoma was made... The B-scan found only vitreous opacities... A staging surgery of a glaucoma valve implantation combined with trabeculectomy surgery was performed on the patient because of the uncontrolled IOP... When he visited us again after a long hiatus, an intraocular mass had been found in another hospital... At this time, a B-scan showed a moderate to low echogenic intraocular mass and a UBM also confirmed a mass both in the anterior chamber and behind the iris... In addition, a mild protopsis of the eye was showing... Based on this, a follow-up CT examination found a tumor in the brain and orbit... Pasternak et al. reported a patient with tumor-related glaucoma, where subconjunctival tumor spread occurred after glaucoma filtering surgery... In our study, a metastatic cancer was found in the conjunctiva in one case.

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A patient with choroid melanoma appeared as primary acute angle-glaucoma in the first visit. The initial signs of the patient were red eye, hydropic cornea, mixed congestion and mydriasis (a); hyphema appeared on the 2nd day (b, arrow). Obvious chemosis on the 3rd day after initial symptoms appeared (c, arrow), and at the same time, a moderate-low echogenic mass found by B-scan (d, arrow), while the ultrasound biomicroscopy (UBM) did not find a mass (e). An intraocular mass was detected by magnetic resonance imaging (f). Another patient with iris-ciliary body melanoma misdiagnosed as primary chronic angle-closure glaucoma. A neoplasm could be seen at about from 10’ clock to 1’clock through slit-lamp (g). In the corresponding place, a nodule was detected by gonioscope (h). A mass in the iris and ciliary-body was found via UBM (i). Meantime, UBM found the adhesion of the anterior Chamber angle from 10’ clock to 1’clock; on the other hand, the mass was not found by B-scan (j). The patient had a good result after an iris-ciliary body tumor reduction surgery (k).
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Figure 1: A patient with choroid melanoma appeared as primary acute angle-glaucoma in the first visit. The initial signs of the patient were red eye, hydropic cornea, mixed congestion and mydriasis (a); hyphema appeared on the 2nd day (b, arrow). Obvious chemosis on the 3rd day after initial symptoms appeared (c, arrow), and at the same time, a moderate-low echogenic mass found by B-scan (d, arrow), while the ultrasound biomicroscopy (UBM) did not find a mass (e). An intraocular mass was detected by magnetic resonance imaging (f). Another patient with iris-ciliary body melanoma misdiagnosed as primary chronic angle-closure glaucoma. A neoplasm could be seen at about from 10’ clock to 1’clock through slit-lamp (g). In the corresponding place, a nodule was detected by gonioscope (h). A mass in the iris and ciliary-body was found via UBM (i). Meantime, UBM found the adhesion of the anterior Chamber angle from 10’ clock to 1’clock; on the other hand, the mass was not found by B-scan (j). The patient had a good result after an iris-ciliary body tumor reduction surgery (k).

Mentions: Among them, case 1 was referred to the emergency department due to her symptoms and was diagnosed as primary acute angle-closure glaucoma in the first visit [Figure 1a]. However, on the 2nd and 3rd days, a rapid progression, hyphema, and obvious chemosis appeared [Figure 1b and 1c]. Considering the curious nature of this phenomenon, further examination was undertaken. A large mass was discovered by B-scan ultrasound [Figure 1d] but not with UBM [Figure 1e]. At the same time, MRI prompted the possibility of choroid melanoma [Figure 1f]. The patient underwent enucleation and was diagnosed with choroid melanoma of the right eye after a pathological evaluation. Case 2 was diagnosed with primary chronic angle-closure glaucoma. What was special about case 2 was that brown nodules in the iris and many pigment depositions were found in the trabecular meshwork in the corresponding place of the anterior synechia under a slit-lamp [Figure 1g] and gonioscope [Figure 1h]. Then, a UBM [Figure 1i] was immediately conducted and found a 4.5 mm × 3.5 mm iris-ciliary body mass. On the other hand, a B-scan [Figure 1j] did not find an obvious mass. The patient received local tumor removal, and the diagnosis of iris-ciliary melanoma was confirmed by pathological examination. After the surgery, the patient obtained a good result [Figure 1k].


Eye tumors misdiagnosed as glaucoma.

Yang M, Wang W, Yan JH, Li XY, Zhou MW, Huang WB, Zhang XL - Chin. Med. J. (2015)

A patient with choroid melanoma appeared as primary acute angle-glaucoma in the first visit. The initial signs of the patient were red eye, hydropic cornea, mixed congestion and mydriasis (a); hyphema appeared on the 2nd day (b, arrow). Obvious chemosis on the 3rd day after initial symptoms appeared (c, arrow), and at the same time, a moderate-low echogenic mass found by B-scan (d, arrow), while the ultrasound biomicroscopy (UBM) did not find a mass (e). An intraocular mass was detected by magnetic resonance imaging (f). Another patient with iris-ciliary body melanoma misdiagnosed as primary chronic angle-closure glaucoma. A neoplasm could be seen at about from 10’ clock to 1’clock through slit-lamp (g). In the corresponding place, a nodule was detected by gonioscope (h). A mass in the iris and ciliary-body was found via UBM (i). Meantime, UBM found the adhesion of the anterior Chamber angle from 10’ clock to 1’clock; on the other hand, the mass was not found by B-scan (j). The patient had a good result after an iris-ciliary body tumor reduction surgery (k).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4837850&req=5

Figure 1: A patient with choroid melanoma appeared as primary acute angle-glaucoma in the first visit. The initial signs of the patient were red eye, hydropic cornea, mixed congestion and mydriasis (a); hyphema appeared on the 2nd day (b, arrow). Obvious chemosis on the 3rd day after initial symptoms appeared (c, arrow), and at the same time, a moderate-low echogenic mass found by B-scan (d, arrow), while the ultrasound biomicroscopy (UBM) did not find a mass (e). An intraocular mass was detected by magnetic resonance imaging (f). Another patient with iris-ciliary body melanoma misdiagnosed as primary chronic angle-closure glaucoma. A neoplasm could be seen at about from 10’ clock to 1’clock through slit-lamp (g). In the corresponding place, a nodule was detected by gonioscope (h). A mass in the iris and ciliary-body was found via UBM (i). Meantime, UBM found the adhesion of the anterior Chamber angle from 10’ clock to 1’clock; on the other hand, the mass was not found by B-scan (j). The patient had a good result after an iris-ciliary body tumor reduction surgery (k).
Mentions: Among them, case 1 was referred to the emergency department due to her symptoms and was diagnosed as primary acute angle-closure glaucoma in the first visit [Figure 1a]. However, on the 2nd and 3rd days, a rapid progression, hyphema, and obvious chemosis appeared [Figure 1b and 1c]. Considering the curious nature of this phenomenon, further examination was undertaken. A large mass was discovered by B-scan ultrasound [Figure 1d] but not with UBM [Figure 1e]. At the same time, MRI prompted the possibility of choroid melanoma [Figure 1f]. The patient underwent enucleation and was diagnosed with choroid melanoma of the right eye after a pathological evaluation. Case 2 was diagnosed with primary chronic angle-closure glaucoma. What was special about case 2 was that brown nodules in the iris and many pigment depositions were found in the trabecular meshwork in the corresponding place of the anterior synechia under a slit-lamp [Figure 1g] and gonioscope [Figure 1h]. Then, a UBM [Figure 1i] was immediately conducted and found a 4.5 mm × 3.5 mm iris-ciliary body mass. On the other hand, a B-scan [Figure 1j] did not find an obvious mass. The patient received local tumor removal, and the diagnosis of iris-ciliary melanoma was confirmed by pathological examination. After the surgery, the patient obtained a good result [Figure 1k].

View Article: PubMed Central - PubMed

Affiliation: Department of Strabismus and Amblyopia, State Key Laboratory of Ophthalmology, Sun Yat sen University, Guangzhou, Guangdong 510060, China.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

They can be misdiagnosed as glaucoma because of red eye, pain, severe headache, elevated intraocular pressure (IOP), even adhesion of the angle of the anterior chamber... In a study by Shields et al., 58 in 144 (40%) of patients with iris melanoma were diagnosed as glaucoma on their initial visit... The total of 9 patients with eye tumors were misdiagnosed as glaucoma at their first visit... These patients included one case of choroid melanoma, one case of iris and ciliary body melanoma, one case of ciliary body medulloepithelioma, one case of intraocular metastases, one case of optic nerve sheath meningioma, and four cases of retinoblastoma... Then, a UBM [Figure 1i] was immediately conducted and found a 4.5 mm × 3.5 mm iris-ciliary body mass... On the other hand, a B-scan [Figure 1j] did not find an obvious mass... When he came to us, the diagnosis of secondary glaucoma was made... The B-scan found only vitreous opacities... A staging surgery of a glaucoma valve implantation combined with trabeculectomy surgery was performed on the patient because of the uncontrolled IOP... When he visited us again after a long hiatus, an intraocular mass had been found in another hospital... At this time, a B-scan showed a moderate to low echogenic intraocular mass and a UBM also confirmed a mass both in the anterior chamber and behind the iris... In addition, a mild protopsis of the eye was showing... Based on this, a follow-up CT examination found a tumor in the brain and orbit... Pasternak et al. reported a patient with tumor-related glaucoma, where subconjunctival tumor spread occurred after glaucoma filtering surgery... In our study, a metastatic cancer was found in the conjunctiva in one case.

Show MeSH
Related in: MedlinePlus