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PHOTO ESSAY
Year : 2022  |  Volume : 2  |  Issue : 2  |  Page : 573-574

Unilateral open-angle glaucoma associated with ipsilateral Naevus of Ota


Department of Ophthalmology, Grant Govt. Medical College, JJ Hospital, Byculla, Mumbai, Maharashtra, India

Date of Submission02-May-2021
Date of Acceptance15-Sep-2021
Date of Web Publication13-Apr-2022

Correspondence Address:
Sumeet Lahane
Grant Govt. Medical College, JJ Hospital, Byculla, Mumbai 400008, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1067_21

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  Abstract 


Keywords: Glaucoma, naevus of Ota, oculodermal melanocytosis, trabecular pigmentation, unilateral glaucoma


How to cite this article:
Dhaytadak P, Philip N, Lahane S, Meghana K R, Parekh R, Lahane T. Unilateral open-angle glaucoma associated with ipsilateral Naevus of Ota. Indian J Ophthalmol Case Rep 2022;2:573-4

How to cite this URL:
Dhaytadak P, Philip N, Lahane S, Meghana K R, Parekh R, Lahane T. Unilateral open-angle glaucoma associated with ipsilateral Naevus of Ota. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 May 18];2:573-4. Available from: https://www.ijoreports.in/text.asp?2022/2/2/573/342866



A 24-year-old male of Indian origin presented with diminution of vision in the left eye (LE) which was painless and progressive over a year. His best-corrected visual acuity at presentation was 6/6 in the eight eye (RE) and 6/9 in LE. Anterior segment (LE) showed 360° melanocytosis with conjunctival nevus 3 × 2 mm nasal quadrant and periocular pigmentation [Figure 1]a,[Figure 1]b,[Figure 1]c,[Figure 1]d Intraocular pressure was 12 and 28 mmHg in RE and LE, respectively on Goldmann applanation tonometer. Optic disc in RE was normal [Figure 1]e and LE had 0.9 cup-disc ratio (C/D) with inferior notching [Figure 1]f. Gonioscopy showed that open angles in RE and LE angle structures were obscured by heavy pigmentation [Figure 1]b. Visual fields showed superior and inferior arcuate scotoma in the LE [Figure 2]. Spectral-Domain Optical Coherence Tomography showed normal optic nerve head in RE and glaucomatous excavation with thinning of retinal nerve fiber layer in all the quadrants in LE. Our impression was uniocular open-angle glaucoma associated with oculodermal melanocytosis (ODM), and his IOP was controlled on timolol 0.5%, dorzolamide 2% and travoprost 0.004%. The patient was counselled and planned for LE trabeculectomy surgery.
Figure 1: (a) Photograph demonstrating peri-ocular pigmentation of the left eye. (b) Gonioscopy of the left eye showing angle structures obscured by heavy pigmentation (c and d) clinical picture showing bluish-gray pigmentation of the left sclera. (e) Fundus photography of the right eye shows normal optic disc; (f) left eye optic disc shows signs of advanced glaucoma (C/D 0.9), with inferior notching

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Figure 2: Humphrey visual field using the Swedish interactive thresholding algorithm Standard, shows superior and inferior arcuate scotoma in left eye

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  Discussion Top


ODM is a benign pigmentary dermal melanocytosis and is associated with choroidal melanoma, glaucoma.[1] Since its description, 51 cases of ODM with glaucoma have been reported in the world literature.[1],[2],[3],[4],[5] Shields et al.[4] evaluated 7872 cases of uveal melanoma, and ODM was present in 230 cases (3%). In total, 85.7% patients presented nevus of Ota at birth, 14.3% reported their appearance in puberty and 14.3% patients had a family history of the disease.[3]

Scleral involvement occurring in two-thirds of cases is associated with an increased risk of developing glaucoma.[2] Shields et al.[4] described obstruction of aqueous outflow by accumulated melanocytes in an open angle as the most likely mechanism in ODM. Teekhasaenee et al. described histopathologic findings in case of absolute glaucoma in which iris melanocyte proliferation over the filtration angle was noted and showed electron microscopic findings of glaucomatous eyes in ODM as accumulation of melanocytes in the trabecular meshwork and the outer wall of Schlemm's canal.[5] Contrary to all studies Cronemberger et al.[3] suggested melanocytic infiltration of the meshwork might not be the sole factor responsible for the development for glaucoma, based on eight patients they studied with intensively pigmented angle and no glaucomatous changes. Limitation of no long-term follow-up, progressive pigmentation of ocular structures, and various ages of presentation of patient are and only 10% reported incidence of glaucoma among nevus of Ota patients could be an explanation for discrepancy between the presence of trabecular pigmentation and absence of disc changes. This is seconded by Magarasevic et al.[2] that glaucoma can appear 5 years after the presence of intense angle pigmentation. This stresses the fact of need for close follow–up and frequent monitoring in cases of ODM for development of glaucoma.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgements

Dr. Sheetal Munde.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Arif NN, Henkind P. Ophthalmologic oncology: Nevus of ota. J Dermatol Surg Oncol 1979;5:186-7.  Back to cited text no. 1
    
2.
Magarasevic L, Abazi Z. Unilateral open-angle glaucoma associated with the ipsilateral nevus of ota. Case Rep Ophthalmol Med 2013;2013:924937.  Back to cited text no. 2
    
3.
Cronemberger S, Calixto N, Freitas HL. Nevus of ota: Clinical-ophthalmological findings. Rev Bras Oftalmol 2011;70:278-83.  Back to cited text no. 3
    
4.
Shields CL, Kaliki S, Livesey M, Walker B, Garoon R, Bucci M, et al. Association of ocular and oculodermal melanocytosis with the rate of uveal melanoma metastasis: Analysis of 7872 consecutive eyes. JAMA Ophthalmol 2013;131:993-1003.  Back to cited text no. 4
    
5.
Teekhasaenee C, Ritch R, Rutnin U, Leelawongs N. Glaucoma in oculodermal melanocytosis. Ophthalmology 1990;97:562-70.  Back to cited text no. 5
    


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