Trabeculectomy in an unsuspected extramedullary iris–ciliary body plasmacytoma

Abstract

Extramedullary plasmacytoma of the iris and ciliary body is extremely rare. We present a case which was misdiagnosed as granulomatous uveitis with neovascular glaucoma, and underwent a trabeculectomy with mitomycin-c along with iris biopsy. The post-operative period showed early bleb failure and catastrophic growth of the suspected mass. Histopathological examination revealed a diagnosis iris plasmacytoma. Subsequent ultrasound biomicroscopy showed involvement of the iris and ciliary body. A prompt systemic workup was done, and an associated systemic plasma cell dyscrasia was ruled out. The affected eye was enucleated, and the patient remains disease free at the end of 3-year follow-up.

Intraocular plasmacytoma: A case of iris involvement and a review of the literature

“… 4 , 16 For the 5 (29%) cases that presented with SEMP and had reported follow-up, there was no evidence of development of multiple myeloma after mean follow-up of 5 years (range 3–9 years). 6 , 8 , 11 , 12 , 17 For the 8 (47%) patients with multiple myeloma and reported follow-up, 4 (50%) patients died from multiple myeloma-associated complications, 3 (38%) patients had systemic disease improvement with treatment, and our case had systemic disease progression with local ocular tumor regression. 4 , 7 , 9 , 10 , 13 , 15 , 16 …”

“…Systemic MM progression. 59 17 M N/A N Iris, Ciliary body Y Enucleation for secondary glaucoma N/A 3 years Ocular tumor regression. No evidence of MM.…”

“… 7 , 13 The remaining patients were treated with intravitreal and systemic chemotherapy (n = 2, 12%), 14 , 15 systemic chemotherapy alone (n = 2, 12%), 4 , 16 or primary enucleation for secondary glaucoma (n = 2, 12%). 17 , 18 The two patients that were treated with intravitreal and systemic chemotherapy demonstrated ocular tumor regression. 14 , 15 The two patients that were treated with systemic chemotherapy alone expired within 6 months of ocular tumor detection from complications associated with multiple myeloma.…”

Huge Lateral Rectus Solitary Plasmacytoma Causing Shunt Extrusion

“…They present as an orbital mass, epibulbar mass [ 9 ], orbital abcess [ 6 ], chalazion [ 6 ], dacryocystitis [ 6 ], granulomatous uveitis or as an isolated mass in the rectus muscles [ 4 , 10 ]. An increase in the IOP or neovascular glaucoma has also been reported in the iris and ciliary body plasmacytomas [ 11 ]. Most of the reported cases of ocular plasmacytomas have associations with systemic multiple myeloma, which makes our case unique that there was no systemic involvement of the disease in our patient.…”