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Case Report/Case Series |

Inadvertent Implantation of Aqueous Tube Shunts in Glaucomatous Eyes With Unrecognized Intraocular Neoplasms: Report of 5 Cases

Swathi Kaliki, MD1,2,3; Ralph C. Eagle Jr, MD1; Hans E. Grossniklaus, MD4; R. Jean Campbell, MD5; Carol L. Shields, MD2; Jerry A. Shields, MD2
[+] Author Affiliations
1Department of Ophthalmic Pathology, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania (Drs Kaliki and Eagle)
2Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania (Drs Kaliki, C. L. Shields, and J. A. Shields)
3Ocular Oncology Service, L. V. Prasad Eye Institute, Hyderabad, India (Dr Kaliki)
4Department of Ophthalmology, Emory University, Atlanta, Georgia (Dr Grossniklaus)
5Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota (Dr Campbell)
JAMA Ophthalmol. 2013;131(7):925-928. doi:10.1001/jamaophthalmol.2013.828.
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Intraocular tumors are a recognized cause of secondary glaucoma. Mechanisms of tumor-related glaucoma include direct tumor invasion or infiltration of the anterior chamber angle, pupillary block caused by anterior displacement of iris-lens diaphragm in the eyes with tumors located posterior to the iris, melanomalytic or melanocytomalytic glaucoma, tumor-induced neovascular glaucoma, inflammatory glaucoma secondary to tumor necrosis, hemolytic glaucoma, and glaucoma due to elevated episcleral venous pressure secondary to extraocular tumor extension.1 A survey of 2704 eyes with intraocular tumors revealed tumor-related glaucoma in 126 eyes (5%) including uveal melanoma (55 of 2111 [3%]), uveal metastases (12 of 256 [5%]), retinoblastoma (51 of 303 [17%]), intraocular lymphoma (3 of 11 [27%]), intraocular leukemia (1 of 11 [9%]), ciliary body medulloepithelioma (2 of 2 [100%]), iris melanocytoma (1 of 1 [100%]), and iris pigment epithelial adenoma (1 of 2 [50%]).1

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Figure 1.
Case 1

Case 1 with red eye before aqueous tube shunt (A) developed an anterior chamber mass 3 months postaqueous tube shunt (B). C, Gross examination of the eye confirmed anterior chamber mass adjacent to intracameral tube of aqueous shunt (arrow). D, Microscopic examination revealed ciliary body medulloepithelioma with extension into the anterior chamber (hematoxylin and eosin stain, original magnification ×10). E, Gross examination of the aqueous shunt showed a Molteno glaucoma implant. F, Microscopic examination of the aqueous shunt confirmed tumor seeding in the valve reservoir (hematoxylin and eosin stain, original magnification ×10).

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Figure 2.
Case 5

Case 5 with mild corectopia and cellular debris on the inferior iris surface and inferior angle (A); cytopathology of material obtained by anterior chamber tap revealed epithelioid melanoma cells (A, inset). B, Enucleation of the right eye confirmed diffuse iris melanoma (hematoxylin and eosin stain, original magnification ×10). Tumor cells were found within the fibrous capsule of the Molteno reservoir (C, hematoxylin and eosin stain, original magnification ×10) and confirmed on higher magnification as epithelioid melanoma cells (D, hematoxylin and eosin stain, original magnification ×40).

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