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The authors present a case of a 60 years old patient which is under a 6 years treatment already for open angle glaucoma. In addition the patient present pigmentary epithelial iris tumor.

Objective: To correlate ultrasound biomicroscopic images of iris and ciliary body melanomas with their histopathologic features., Methods: Ultrasound biomicroscopy was performed in 3 cases of iris melanoma and in 3 cases of ciliary body melanoma. Cross-sectional ultrasound biomicroscopic images were compared with findings from clinical examination and light microscopy to evaluate associations between their histopathologic, surface, and internal ultrasound characteristics. Unique images of intrastomal and obscured posterior tumor margins were visualized by ultrasound biomicroscopy., Results: Results of this study revealed that ultrasound biomicroscopy offers an accurate method to evaluate tumor shape, reflectivity, and local invasion. Neoplastic tissue had only medium echogenicity. Enlarged vessels were correlated to echolucent spaces in the iris stroma. Anterior tumor margins were found within the iris stroma, within the anterior chamber angle, and on the endothelial surface of the cornea. Posterior tumor extension was noted to encroach onto the lens, into the sclera, and serous peripheral retinal detachments were associated with ciliary body tumors., Conclusion: Ultrasound biomicroscopic images correlated well with histopathologic features of anterior uveal melanomas including shape, reflectivity, and local extension. Arch Ophthalmol. 2000;118:1515-1521

Purpose: To describe two eyes from two patients with multifocal primary intraocular melanoma., Design: Two case reports., Methods: The history and histologic findings in the enucleated eyes of two patients with multifocal intraocular melanoma are described in comparison to previously reported cases., Main Outcome Measures: Pathologic examination of enucleated eyes., Results: One of the two eyes contained mixed cell type melanomas, and one eye contained spindle cell type melanomas. Examination of serial sections showed no continuity between the intraocular melanomas. There were no associated ocular or systemic conditions with the multifocal intraocular melanomas., Conclusions: Multifocal primary intraocular melanoma is rare. There is no known predisposing factor to this condition.

Introduction: It is difficult to classify lesions of the iris, especially when they are posterior or in the iridociliary angle of the eye., Method: We used an ultrasound biomicroscope (Humphrey, Zeiss, Oberkochen, Germany) with a high-frequency sound head (30 and 50 Hz). This study included all patients with unspecified iris processes who were examined at the University Eye Clinic and Hospital of Ulm between September 1996 and February 1997. Fifteen patients, aged between 9 to 82 years (average age = 48.9 years), were prospectively evaluated., Results: A cyst of the iris or ciliary body causing a tumor of the iris was found in six cases (40%). Seven patients (47%) showed a solid tumor of the iris and two patients (13%) a solid tumor of the ciliary body., Conclusion: The ultrasound biomicroscope can be used to assess lesions of the iris caused by a cyst or a solid tumor. The increasing size and depth expansion of a solid tumor may be helpful for differentiating between a malignant or benign process. Up to now it has not been possible to use the ultrasonic reflectivity of the tumor to decide if it is malignant.

Objective: This study aimed to correlate histologic characteristics with high-frequency ultrasound backscatter spectra in malignant melanomas of the iris., Design: The study design was a cohort (case series) study of patients diagnosed with iris melanoma in the authors' clinic., Participants: Sixteen patients with iris melanoma participated., Intervention: The patients were scanned with a 50-MHz ultrasound unit equipped for digitization of raw echo data. Spectral parameter images representing the spatial distribution of size and concentration of tissue inhomogeneities were produced., Main Outcome Measures: The variation of spectral properties within and between tumors was determined. In the two tumors in this series for which histologic material was available, the authors compared scatterer concentration and size with histology and mathematically modeled the effect of melanocyte distribution on spectra., Results: Ultrasound scattering characteristics differed considerably among tumors. Where histology was available, acoustic parameters correlated with the size and number of melanocytes present., Conclusions: Iris melanomas exhibited a wide range in acoustic backscatter properties. Whereas characteristics such as vascularity and necrosis might contribute to this, in the two cases examined here, backscatter characteristics could be largely accounted for by melanocyte distribution. A better understanding of the relationship of histology to noninvasive ultrasound data will enhance the diagnostic utility of this technique.

Purpose: To evaluate the use of ultrasound biomicroscope (UBM) in imaging anterior segment tumors of eye., Methods: 13 cases of anterior segment tumors of eye were examined with UBM., Results: 3 cases had the ocular history of trauma or surgery and were clinically diagnosed as anterior iris cysts. UBM displayed the cysts as thin-walled, no internal reflectivity, and at the locate of anterior humour angle; 8 cases had superficial anterior humour, narrow anterior angle and clinically be suspected as tumors behind iris or ciliary body. UBM showed cystic reflectivity in 7 cases and a solid tumor in ciliary body in one case. 2 cases were clinically diagnosed as iris nevi. UBM displayed solid convex lesions., Conclusion: UBM is a valuable new technique in the diagnosis and accurate localization of anterior segment tumors.

A case of high, broad, peripheral anterior synechiae caused by multiple, bilateral iridociliary cysts is reported. The peripheral anterior synechia in our case extended to the corneal endothelium beyond Schwalbe's line, and iris atrophy in the region of the cysts was found. Ultrasound biomicroscopic imaging showed that multiple, bilateral iridociliary cysts causes elevation of the iris structure.

Objective: To develop a practical, inexpensive system for 3-dimensional ultrasound biomicroscopic imaging of the anterior segment with a commercially available high-frequency ultrasound imager and a personal computer., Methods: Sequential, high-frequency, ultrasound biomicroscopic images of the anterior segment were obtained with a motorized scanning control arm designed in our imaging laboratory. Images were acquired by a personal computer-based video capture device. Ultrasound slice data were then reconstructed as 3-dimensional volumetric images by a personal computer and commercially available software., Results: Four 3-dimensional visualization formats were developed to enhance the clinical utility of high-frequency ultrasound. Rotational animation sequences were created that detailed the extent and anatomy of a filtering bleb, intraocular lens subluxation, focal angle closure from an iridociliary cyst, intraocular foreign bodies, and an iris tumor., Conclusions: Three-dimensional, high-frequency ultrasound of the anterior segment enhances our ability to visualize spatial relationships between adjacent anatomic structures. The low cost and ease of use of this system make widespread clinical application practical.

I-123-N-(2-Diethylaminoethyl) 4-lodobenzamide (I-123IDAB) has recently been introduced as a radiopharmaceutical agent in the management of patients with malignant melanoma. We tested the diagnostic potential of this substance in 5 patients suspected of having an ocular malignant melanoma. I-123-IDAB scintigraphy identified 4 patients with high tracer uptake in the pathologic eye. Three cases were confirmed histologic as a malignant melanoma, the fourth patient was submitted to radiotherapy. The amelanotic (histologically confirmed) irismelanoma of the fifth patient could not be detected. From these preliminary results we conclude that I-123-IDAB scintigraphy may be a valuable tool for establishing the diagnosis of malignant melanotic melanoma.

Purpose: High-frequency ultrasound allows high-resolution imaging of anterior segment anatomy and pathology. Acoustic echo data, however, contain information relating to the microanatomic structure of the interrogated tissue which is not evident in B-mode images. The aim of this study is to develop imaging techniques to demonstrate and quantify the distribution of acoustic scattering properties in ocular tissues in three dimensions., Methods: A tumor of the iris and a hyphema were scanned using a 50-MHz ultrasound probe mounted on a computer-controlled two-axis positioning system. Scan data from sequential parallel planes were used to make three-dimensional reconstructions. Digital signal processing and a mathematical model of acoustic backscatter then were used to represent the effective size and acoustic concentration of scattering elements using a false color representation superimposed on B-mode images., Results: Three-dimensional reconstructions improved appreciation of the size and extent of pathology and allowed computation of tissue volumes. Parameter images demonstrated distinctive differences between diffuse and organized blood and allowed quantification of tumor scattering properties., Conclusions: Three-dimensional imaging of the anterior segment with high-frequency ultrasound allows construction of perspective images, which adds to the already significant clinical use of individual high-resolution B-mode images. Acoustic backscatter properties determined by tissue microstructure can be computed from echo data and represented in false color in three-dimensional reconstructions.

Purpose: This study was conducted to determine the effect of transducer bandwidth on the characteristics of ophthalmic ultrasound images., Methods: B-scan images produced using two transducers, one with a narrow bandwidth and the other with a broad bandwidth, both having nominal center frequencies of 10 MHz, were evaluated. Comparative scans were made of a tissue-mimicking phantom, an intraocular tumor, and a vitreous hemorrhage., Results: Results showed that broadband transducers gave improved resolution and finer speckle texture, but had lower sensitivity. Broadband transducers were most suitable for situations in which resolution was more important than sensitivity, such as imaging of tumors. The greater sensitivity of the narrowband probe made it most useful for evaluation of vitreous complications, such as hemorrhage and membranes., Conclusion: In addition to transducer frequency, bandwidth should be taken into account when choosing a transducer for a specific ophthalmic imaging application. Both broad- and narrowband transducers have relative advantages in particular applications.

Eighty patients, referred for further evaluation of prominent iris lesions, were examined with conventional B-mode ultrasound equipment combined with a simplified immersion technique. The axial resolution of this system is about 350 microns. In 20.3% of the cases, the lesion was too small for ultrasound detection. A cystic lesion was diagnosed in 26% and a solid lesion in 53.7% of the patients studied. In 33.4% of the cases, the lesions were not confined to the iris but also appeared in the ciliary body. This last result shows the diagnostic value of the conventional ultrasound examination in the evaluation apparent iris lesions.

Ultrasound biomicroscopy (UBM) allows high-resolution imaging of the anterior segment due to ultrasound transducers between 50 and 100 MHz. At present stage of experience, mainly analysis of iris and ciliary body structures seem to be clinically rewarding. This is demonstrated by two similar looking tumors, involving the chamber angle. By means of UBM it was possible to differentiate between cystic and solid growths and to assess tumor extensions.

For several years, immunoscintigraphy (IS) using a 99mTc-labeled monoclonal antibody for tumor localization has been used as an additional tool in the diagnosis of malignant melanoma. The aim of our study was to verify previously published data with respect to our own patients and to correlate immunoscintigraphic results with histological findings. In particular, we wanted to compare the outcome of IS in ocular melanoma with that in cutaneous melanoma. We examined 28 patients (15 females, 13 males, average age 64 years) with clinically suspected ocular melanoma. IS was performed using the monoclonal antibody 225.28S (Tecnemab-K-1, Fa. Sorin/Solco), and images were obtained in a standard fashion (planar) as well as with the SPECT technique. In 16 patients, the tumor was examined afterwards histologically. The control group consisted of 102 patients with histologically proven metastasizing cutaneous melanoma who were investigated by IS in an identical fashion. In contrast to the literature published so far, we demonstrated a positive IS reaction in only 42% (and 56% in histologically proven cases, respectively) in our patients with ocular melanoma, while in patients with cutaneous melanoma, we found a sensitivity of more than 80%. In the 3 patients who turned out not to have ocular melanoma, we found one false-positive reaction (subretinal hemorrhage). No correlation was found between the various histological features of ocular melanoma and the immunoscintigraphic results. We conclude that IS using the antibody 25.28S is of limited value in patients with ocular melanoma and should only be recommended in selected cases.(ABSTRACT TRUNCATED AT 250 WORDS)