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Importance Bilateral diffuse uveal melanocytic proliferation (BDUMP) is a rare paraneoplastic syndrome with characteristic findings, including exudative retinal detachment, rapid cataract formation, and uveal melanocytic tumors. We report a case notable for bilateral iris and ciliary body cysts—a rare presentation of the disease. Observations A woman in her 50s presented with bilateral decreased vision. Her medical history was significant for clear cell adenocarcinoma of the endometrium. Slitlamp examination revealed a contiguous ring of pigmented translucent iris cysts at the pupillary margin of each eye, confirmed with ultrasound biomicroscopy. Ophthalmoscopic examination of the left eye showed a geographic patch of subretinal fluid temporal to the macula that was associated with orange polygonal pigment. The patient underwent periocular injection of triamcinolone acetonide, with resolution of the subretinal fluid. Recurrent fluid was treated successfully with a second injection of triamcinolone. Conclusions and Relevance Our case of BDUMP appears to be the first to demonstrate multiple iris and ciliary body cysts with high-quality color photography and ultrasound biomicroscopy. Involvement of the anterior uveal tract may be more common than reported in the literature because of its occult nature. Ultrasound biomicroscopy and anterior segment optical coherence tomography may be useful in patients with suspected BDUMP to identify anterior uveal tract involvement.

Background Adenoma of the iris pigment epithelium (IPE) is an uncommon lesion that can simulate iris or ciliary body melanoma, melanocytoma, and pigment epithelial cyst. Objectives To evaluate the clinical and pathological features and prognosis of adenoma of the IPE in patients managed by us and to elucidate the features that help to differentiate this tumor from iris melanoma and other similar conditions. Patients and Methods The medical records of 20 patients with adenoma of the IPE were reviewed, and the clinical and histopathologic features were tabulated. Results Ten patients were male and 10 were female, with a mean age of 60.0 years (range, 11-85 years). All patients were referred because of suspected iris or ciliary body melanoma. All lesions were solitary and unilateral. Sixteen were located in the peripheral iris; 2, in the midzone; and 2, near the pupillary margin. Clinically, all tumors were abruptly elevated, all but 1 were dark gray to black, and all had a smooth, but sometimes multinodular, surface. The tumors caused thinning or complete effacement of the overlying iris stroma, but they did not directly involve the stroma. They typically blocked light with transillumination. On ultrasound biomicroscopy findings, adenoma of the IPE shows a solid tumor pattern, sometimes with small cystoid spaces. The tumor was managed by local resection in 2 patients and observation in 18, all of whom have been stable, with follow-up ranging from 6 months to 9 years. Histopathologic examination revealed a tumor originating in the IPE consisting of cords of pigment epithelial cells separated by septae of connective tissue. Conclusions Adenoma of the IPE usually has characteristic features that should differentiate it from iris melanoma, ciliary body melanoma, iris melanocytoma, and iris cyst. Adenoma of the IPE is a benign tumor that may remain relatively stable for years.

Primary iris cysts are unusual ocular abnormalities that may be congenital. We describe a primary iris cyst associated with an iris nevus that spontaneously collapsed within a 1-year followup period. Report of a Case. —A 13-year-old white boy was seen on February 21, 1989, for evaluation of a pigmented iris lesion. The patient had no previous history of ocular surgery or trauma and had not been receiving topical medications. Visual acuity was 20/20 OU. Intraocular pressures and dilated fundus examination results were normal. Slit-lamp examination of the right eye was unremarkable. Slit-lamp examination of the left eye revealed a flat, pigmented lesion occupying a portion of the nasal iris. A focal area of increased pigmentation was present in the adjacent anterior chamber angle by gonioscopy. A round, pigmented iris cyst extending from the

To the Editor. —Spontaneously occurring cysts of the iris not derived from epithelial ingrowth are occasionally observed in clinical practice. Patients usually remain symptom free, but if the cysts enlarge to a sufficient size, they can produce a secondary chronic or acute angle closure glaucoma, compress the iris against the corneal endothelium causing corneal decompensation and/or an inflammatory reaction in the anterior segment of the eye, or obstruct the visual axis.1 Many techniques have been previously advocated for treatment of iris cysts. Recommended therapies range from invasive surgical techniques to argon laser penetration of the cysts.1,2Up to this point, the use of the neodymium-YAG laser has rarely been discussed for the use of iris cyst puncture.3This case report documents our use of a Q-switched neodymium-YAG laser in the management of a patient with an iris cyst which partially blocked the visual field. Report of a

EPITHELIAL cysts arising spontaneously in the iris are classified in two groups—intra-epithelial and stromal. 1 The intra-epithelial cysts are made up of pigmented epithelium, and they are regarded as remnants of von Szily's marginal sinus of the iris that have not been obliterated. 2-3 The stromal cysts are situated within the iris stroma and are lined by nonpigmented epithelium. The latter may be multilayered and may contain goblet cells. The origin of these cysts is still controversial. 2-5 Some observers hold the opinion that they arise from the surface ectoderm displaced, probably, at the time of formation of the lens vesicle. 6-8 Others 9-12 believe that they develop from aberrant cells from the most anterior portion of the optic vesicle whiel it is still unpigmented. The histopathologic features of such cysts excised by iridectomy have been illustrated repeatedly, 1,7-9, 13-18 but we have found only one report describing such

THE LITERATURE contains many reports of traumatic cyst of the iris caused by the implantation of glass or other substances in the eye. Among others who have published articles on this subject is Perera, 1 who in 1937 read a paper before the American Academy of Ophthalmology and Oto-Laryngology on epithelium in the anterior chamber of the eye after operation and injury. On Nov. 28, 1928, I 2 presented before this Section a case in which a fragment of glass had been embedded in the eye for 28 years. In this case a high school student was experimenting in the laboratory with a mixture of sulfuric acid and potassium nitrate in a glass retort, placed over a Bunsen burner; its explosion caused a fragment of glass to penetrate the periphery of the eyeball and become embedded in the retina. The incised scleral wound was closed with three episcleral sutures. This