Medical Care
Regular photographic documentation of the iris mass is necessary in patients with leiomyoma of the iris.
Surgical Care
Conservatism is suggested in the management of demarcated iris tumors, particularly for those tumors in the central part of the iris.
When the visual field is threatened, complete excision of the tumor in the pupillary zone is safe.
Phacoemulsification of sectoral cataracts may be performed. Toric intraocular lens implants may address the corneal astigmatism. [3]
Pupillary repair and reconstruction may be warranted on some occasions.
In primary ciliary body leiomyoma extending into the iris and the anterior chamber (see images below), sclerouvectomy has been found to be beneficial. [6]
Consultations
Ocular pathologist
Having the opinion of a subspecialist may prove worthwhile. Appropriate photographic documentation is necessary.
The specimen obtained during biopsy should be appropriately submitted to an ocular pathologist for proper immunohistochemistry and ultrastructural study.
Long-Term Monitoring
Once a diagnosis of leiomyoma is confirmed by ultrastructural analysis after excisional biopsy, no further treatment of this benign lesion is necessary.
If the excisional biopsy is large, diplopia and glare may potentially become complaints. Addressing these issues appropriately is necessary.
Further Inpatient Care
In some centers, admission may be necessary after performing an excisional biopsy.
Monitoring for infection, wound leakage, anterior chamber depth, and pupillary status is required.
Inpatient & Outpatient Medications
Aside from the use of an eye shield, oral painkillers, and topical antibiotics and steroids after the procedure, no further special care is necessary.
Appropriate topical ophthalmic medications may be provided in the advent of an excisional biopsy.
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Leiomyoma of iris. (A) Spindle cell tumor arising in region of sphincter muscle of iris. Hematoxylin and eosin, X30. (B and C) Tumor is composed of uniform spindle-shaped cells with an abundant admixture of fibrillary cell processes. Hematoxylin and eosin, X500. Armed Forces Institute of Pathology Acc. 68490.
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(A) Incidental iris leiomyoma (arrow) in 16-year-old female with uveitic glaucoma removed at time of glaucoma procedure. Courtesy of Alan L. Robin, MD. (B) Tumor (between arrows) is composed of spindle-shaped cells with an abundant admixture of fibrillar material. Hematoxylin and eosin, X340. (C) The cells stain positively for smooth muscle actin. Immunoperoxidase, X340. EP 96159.
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Ciliary body leiomyoma extending anteriorly.
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Ciliary body leiomyoma extending anteriorly.
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Ciliary body leiomyoma extending anteriorly.
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Ciliary body leiomyoma extending anteriorly.
