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Oncology
Iris freckle: a distinct entity
  1. Yağmur Seda Yeşiltaş1,
  2. Millennia Zhou2,
  3. Emily C Zabor2,
  4. Zackery Oakey3,
  5. Nakul Singh4,
  6. Ahad Sedaghat1,
  7. Gabrielle Yeaney5,
  8. Arun D Singh1
  1. 1 Department of Ophthalmic Oncology, Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, USA
  2. 2 Department of Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, USA
  3. 3 Department of Ophthalmology, Hoag Memorial Presbyterian Hospital, Irvine, California, USA
  4. 4 Department of Ophthalmology, Johns Hopkins Medicine Wilmer Eye Institute, Baltimore, Maryland, USA
  5. 5 Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Dr Arun D Singh; singha{at}ccf.org

Abstract

Purpose To report distinctive clinical and imaging features of iris freckles to differentiate them from iris nevi.

Design Retrospective observational study.

Subjects 53 patients (277 freckles) with incidental iris freckles and 102 patients (104 nevi) with iris nevi that are either clinically stable or pathologically confirmed.

Methods Patient data were collected from the Department of Ophthalmic Oncology, Cleveland Clinic, Cole Eye Institute database (2012–2023). Lesion characteristics were recorded from slit-lamp examination descriptions and review of colour photographs. Ancillary imaging features observed using anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM) were assessed in patients (where available).

Main outcome measures Comparison of clinical and imaging features of iris freckles and iris nevi.

Results A total of 277 iris freckles and 104 iris nevi were analysed. Iris freckles were more frequently bilateral (17%; nevi 0%) and multiple (69%; nevi 2%) and located centrally (89%; nevi 17%) compared with iris nevi (p<0.001). The median freckle largest basal diameter and thickness were 0.8 mm (nevi; 2.1 mm, p<0.001) and 0.04 mm (nevi 1.0 mm, p<0.001), respectively. All iris freckles had irregular margins without any secondary effects compared with iris nevi. Iris freckles appeared flat without effacement of iris folds compared with iris nevi on AS-OCT (p<0.001). Iris freckles were not detectable by UBM. Heat map revealed that freckles demonstrated several features with uniform or near uniform values, whereas nevi demonstrated more variability in values across features.

Conclusions Iris freckles exhibit specific clinical and imaging features reflective of their characteristic histological composition that support their classification as a distinct entity within the spectrum of iris pigmented lesions.

  • Iris
  • Neoplasia
  • Pathology

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/bjo-2023-325009

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Contributors ADS is guarantor. YSY: Study design, data collection, data interpretation, drafting the manuscript and critical revision of the manuscript. MZ and ECZ: Statistical analysis, data interpretation and drafting the manuscript. ZO, NS and AS: data interpretation and critical revision of the manuscript. GY: data collection, data interpretation and critical revision of the manuscript. ADS: Study design, data interpretation, drafting the manuscript and critical revision of the manuscript.

    • Funding This work was supported by a Research to Prevent Blindness Challenge Grant, Department of Ophthalmology, Cleveland Clinic Lerner College of Medicine, Cole Family Endowment for Ophthalmic Oncology, and 2219-International Post-doctoral Research Scholarship Grant by The Scientific and Technological Research Council of Turkey (TUBITAK). The sponsor or funding organisation had no role in the design or conduct of this research.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.