Iris Microhemangiomatosis: Clinical, Fluorescein Angiography, and Optical Coherence Tomography Angiography Features in 14 Consecutive Patients

• Published in: American journal of ophthalmology 2018-12, Vol.196, p.18-25
• Main Authors: Williams, Basil K., Di Nicola, Maura, Ferenczy, Sandor, Shields, Jerry A., Shields, Carol L.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Female; Fluorescein Angiography - methods; Hemangioma - pathology; Humans; Iris - blood supply; Iris Diseases - diagnostic imaging; Iris Diseases - pathology; Male; Microvessels - pathology; Middle Aged; Retrospective Studies; Tomography, Optical Coherence - methods; Visual Acuity
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2018.08.011

To describe the clinical and imaging findings and treatment options in a series of patients with iris microhemangiomatosis. Retrospective observational case series. Setting: Single institution. Study Population: Twenty-two eyes of 14 consecutive patients with iris microhemangiomatosis were reviewed. Observation Procedures: Clinical examination and slit-lamp photography were performed on every patient. Anterior segment optical coherence tomography (AS-OCT), anterior segment optical coherence tomography angiography (AS-OCTA), anterior segment intravenous fluorescein angiography (AS-IVFA), and ultrasound biomicroscopy were performed when possible. Main Outcome Measures: Clinical and imaging features and treatment strategies. Twenty-two eyes of 14 patients with iris microhemangiomatosis were included in this series. Mean patient age was 70 years (range, 58–82 years), and all patients were white. The iris hemangiomatosis appeared as subtle, multifocal, ectatic vascular channels arranged circumferentially at the pupillary margin. Iris color was blue (n = 19 eyes) or green (n = 3 eyes), and the features were unilateral (n = 6 patients) or bilateral (n = 8 patients). Additional features included reduced visual acuity (n = 13 eyes), hyphema (n = 12 eyes), and glaucoma (n = 7 eyes). There was no history of ocular trauma or systemic vasculopathic conditions. AS-OCT documented the fine tuft at the pupillary margin, AS-OCTA showed vascular flow, and AS-IVFA demonstrated pupillary margin vascular lesions with mild staining. Observation was advised in 20 cases (91%), and argon laser photocoagulation was required for repetitive hyphema in 2 cases (9%). Iris microhemangiomatosis is a rare ocular condition, often manifesting with spontaneous unilateral hyphema and/or secondary glaucoma. AS-IVFA confirms the diagnosis, and intervention with laser photocoagulation is necessary in only 9% of eyes.