Clinical case of combined organ-preserving laser treatment of iris neoplasm

Abstract

Purpose To present a clinical case of organ-preserving laser treatment of the iris tumor. Setting/Venue State Institution "The Filatov Institute of Eye Diseases and Tissue Therapy of NAMS of Ukraine" Methods Patient D., 54 years old, with a neoplasm of the iris of the right eye, was admitted to the department of laser eye microsurgery. There were no complaints. Visual acuity of both eyes was 1.0. Intraocular pressure (IOP) of the right eye was 22.0 mm Hg, of the left eye - 17.0 mm Hg. For the further examination of the right eye, we were used: ophthalmoscopy, biomicroscopy, gonioscopy, Maklakov tonometry, ultrasound diagnostics of the anterior segment of the eye, photo of the anterior segment of the eye. During biomicroscopy at 3-4 hours, a three-dimensional, oval-shaped formation is determined in the iris, which protrudes into the anterior chamber, is not pigmented, with multiple hemorrhages, with an uneven (bumpy) surface, penetrated by vessels. During gonioscopy, the angle of the anterior chamber is closed from 3 to 4 o'clock. Ophthalmoscopy is unremarkable. During ultrasound examination, a medium echogenic volume formation of a small oval-shaped structure is determined in the iris at 3-4 o'clock, the size of the neoplasm was 3.6 by 4.2 mm, the thickness - 2.4 mm. No focal volumetric pathology in the ciliary body. Due to the examinations, the diagnosis "Leiomyoma-type iris neoplasm, secondary glaucoma of the right eye" was made. Results The treatment consisted of: 1) anti-inflammatory drug therapy (instillation of bromfenac 1 drop 3 times/day for 2 months) 2) organ-preserving laser therapy: laser coagulation of the iris neoplasm (3 sessions), transscleral cyclophotocoagulation (1 session), laser iridotomy at 11 o'clock. After 4 months. During ultrasound examination at 3-4 o'clock in the iris, a volumetric formation of a small oval-shaped structure of medium echogenicity was determined, the dimensions of the iris neoplasm were 3.4 by 3.7 mm, and the thickness was 1.6 mm. No focal volumetric pathology in the ciliary body. After three courses of treatment, the patient has positive dynamics: a decrease in the thickness of the neoplasm to 1.3 mm and dimensions - to 3.4 mm by 3.1 mm, obliteration of newly formed vessels is noted. Visual acuity - 1.0. IOP of the right eye - 16.0 mm Hg. IOP monitoring at the place of residence is recommended. Follow-up after 6 months. Conclusions The effectiveness of treatment of iridociliary zone tumors in advanced cases is difficult, which may lead to enucleation due to the continued growth of the tumor into the anterior chamber angle and the development of uncompensated neovascular glaucoma. From clinical experience, organ-preserving treatment such as laser coagulation with 570 nm wavelength and transscleral laser cyclophotocoagulation with 1064 nm wavelength allows to reduce tumor growth and the development of newly formed vessels, as well as to prevent thedevelopment of secondary neovascular glaucoma. In our clinical case, the iris neoplasm responded well to organ-preserving treatment (laser coagulation and transscleral laser cyclophotocoagulation), which allowed to reduce tumor growth and obliterate newly formed vessels with an improvement in the clinical picture and according to ultrasound data.