Necrotic iris melanocytoma with secondary glaucoma.

A 54-year-old female was referred because of a pigmented iris lesion with uncontrolled glaucoma in the left eye. The intraocular pressure (IOP) was 54 mm Hg despite anti-glaucoma medications. Her visual acuity (VA) was 20/100. A slit-lamp examination showed corneal edema and a darkly pigmented small iridociliary lesion (Ultrasound biomicroscopy: 5 mm × 3 mm × 2 mm) with diffuse pigment shedding onto the anterior iris surface and diffuse circumferential pigmentation of the trabecular meshwork with wide-open angle (gonioscopy). Diagnostic fine needle aspiration biopsy of the main tumor and anterior chamber lavage were performed. Cytology revealed polygonal cells with dense intracytoplasmic pigment obscuring nuclear details diagnostic of a melanocytoma. During follow-up, as the tumor continued to cause new pigment shedding with high IOP, therefore, excision of the primary tumor via iridocyclectomy was performed. At postoperative 1 month, the IOP was 13 mm Hg with maximal medical therapy for glaucoma requiring glaucoma shunt surgery. At 6 months, the IOP remained below 13 mm Hg and the VA was 20/50 without recurrence of pigment shedding. Necrotic iris melanocytoma, though rare, can lead to pigment dispersion glaucoma. Surgical excision of the primary tumor, coupled with glaucoma surgery, proved effective in controlling intraocular pressure and preserving vision in this case.