|Year : 1965 | Volume
| Issue : 2 | Page : 62-64
Iris pigment in ocular melanomata
Dept. of Ophthalmology, Institute of Post Graduate Medical Education and Research, Chandigarh, India
|Date of Web Publication||21-Feb-2008|
S D Paul
Dept. of Ophthalmology, Institute of Post Graduate Medical Education and Research, Chandigarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Paul S D. Iris pigment in ocular melanomata. Indian J Ophthalmol 1965;13:62-4
Incidence of malignant melanomas of the eye appears to be more in the Western Hemisphere as evidenced by frequent case reports in Western Journals.
Affirmation of this statement is borne out of a report published by the Registry of Pathology, Armed Forces Institute of Pathology, Washington, D.C. (Reese-1951). A survey of 5,000 cases of malignant melanomas of the eye was reported and it was found that only eight cases of malignant melanomas were known to occur in nonwhite people.
This becomes an interesting problem when one visualises that the nonwhite people are rich in pigment which incidentally also holds good for the inner eye.
With this view in mind a possible correlation was sought between the pigmentation of the iris and the incidence of malignant melanomas of the posterior uvea in the same eye.
It may be pointed out here that other workers have tried to establish a correlation between the occurrence of pigment cell clusters in the iris and the presence of malignant melanomas in the posterior uvea. Rees (1944) in a published report mentioned a definite correlation between the occurrence of benign melanomas of the iris and malignant melanomas of the Posterior uveal tract.
Wilder (1948) in another report described an increased number of pigment cell clusters or benign melanomata of the iris in the eyes of patients, who already had malignant melanomas of the choroid.
It may be pointed out here that once the diagnosis of malignant melanoma is made, the eye more often than not is doomed and the treatment is rather drastic. Yet it is an established fact that the spindle type A (Callender and Wilder classification-1935) variety of the melanoma is almost benign in nature as compared to the other histological types. The nature of the tumour unfortunately can only be established on histopathological study, which can only be done satisfactorily after an enucleation has been performed. In order to obviate this drastic step this study is undertaken, to investigate any probable correlation between the pigmentation of the iris with the state of malignancy of malignant melanoma of the posterior uvea as established by the cell types in the living eye.
| Material and Methods|| |
One hundred and four cases of malignant melanomas were investigated histopathologically. Out of these, 74 were adequately followed for varying periods of time from 1949-1956.
The series was selected from a hospital where the outpatient attendance of the nonwhite people was fairly high. Incidentally in this series of malignant melanomas not a single patient belonged to the nonwhite race.
Histologically the iris pigment was grouped into 4 categories, depending on the amount of pigmentation. The categories being light, medium, moderate and heavy. An analysis in this series indicated the following:[Table - 1]
The association of the iris pigment to the incidence of melanomas in the eye was evident from the above table. The majority of the tumour bearing eyes in the above table had moderately pigmented irides. In other words heavily pigmented irises and malignant melanomas did not occur in the same eye very frequently. It may be pointed out that a majority of cases fell in the medium and moderate variety of iris pigment.
A further analysis of these cases according to the cell types (of the melanomas) indicated the following:-[Table - 2]
More of the mixed and spindle type B tumour bearing eyes had mediumly pigmented irides, while, the epitheloid and the fascicular type of tumour bearing eyes had moderately pigmented iridis.
74 patients were followed and the following was noted.[Table - 3]
25 per cent of deaths occurred in eyes with moderately pigmented iris, 25 per cent of deaths occurred in heavy pigmented irides, while patients with eyes which had lightly pigmented irides had the least curtailing in this group (7 per cent).
| Discussion|| |
From the above mentioned figures, it emerges that, most of the intraocular malignant melanomas were not associated with lightly pigmented irides. This can be put in another way that people with grey, blue or lightly coloured irises are less prone to malignant melanomas. It also emerges from those findings that amongst the irides it is in only those eyes which have medium or moderate pigmentation of the iris that the occurrence of malignant melanomas is common. In eyes with heavily pigmented iris the incidence of malignant melanomas was very much less.
The report of Reese (1951), Dean (1956), Paul (1959) and the Registery of Armed forces of Pathology Walter Reed Army Medical Centre Washington D.C. confirms the view that malignant melanomas are more prone to occur in the white race. A deduction from the above amounts to, that those people having heavily pigmented iridis are less prone to malignant melanoma. This has been substantiated by the findings recorded in this article.
A further analysis of the distribution and correlation of the iris pigment to the cell type of the tumour indicates that more of the mixed type and spindle type B of tumour bearing eyes had mediumly pigmented irides, while the epitheloid and the fascicular type of tumour bearing eyes had moderately pigmented irides. This finding might have some clinical importance in the early diagnosis of the cell type and the cell combination in the tumour bearing eye before enucleation.
Mortality rate was noted to be high in patients having moderately pigmented irides.
| Conclusion|| |
- Tumour bearing eyes predominated in having medium or moderate type of iris pigment.
- Heavily pigmented irides did not share in the high incidence of malignant melanomata.
- A possible clinical corellation can be made from the pigmentation to the iris to the histological cell type of the tumour.
The Author acknowledges the helpful cooperation of the Authorities of the Wills Eye Hospital, Philadelphia. for permission and help to review the clinical material.
The Author also gratefully acknowledges the helpful guidance of Professor I. H. Leopold in pursuing this study.
| References|| |
Callender G. R. (1931): Tr. Am. Acad. Ophth. 131, 1931.
Callender G. R. and Wilder H. C. (1935): Amr. J. Cancer, 25, 251.
Deen C. (1956): Kresge Eye Institute. Bull. 7, 1
Paul S. D. (1959): Indian J. of Med. Sciences. 13, 191 (1959).
Reese A. B. (1944): AMA Arch. of Ophthal, 27, 217.
Reese A. B. (1951): Tumours of the Eye. Hoeber New York. pp. 201, 218. 221, 222, 225, 228, 229, 272, 303.
Wiider H. C. (1948): Relationship of pigment cell clusters in the iris to malignant melanoma of the tiveal tract. Special publications of the New York Academy of Sciences 4, 1 and 137.
[Table - 1], [Table - 2], [Table - 3]