An Iris Tumor Secondary to Talaromyces Marneffei Infection in a Patient with AIDS and Syphilis.

PURPOSE: To report a case of iris tumor secondary to Talaromyces marneffei infection in a patient with AIDS and syphilis. CASE REPORT: A 25-year-old man presented with gradual vision decrease in the right eye for 2 months. Ocular examination revealed best-corrected visual acuity (BCVA) of 0.12 and a vascularized and solid tumor at inferotemporal iris base in the right eye. There were some papulonecrotic skin lesions. Both serum treponema pallidum particle agglutination and human immunodeficiency virus antibody were positive. Non-target metagenome next-generation sequencing detected Talaromyces marneffei in the skin lesion and aqueous humor. After 8 weeks of oral voriconazole and fluconazole eyedrop treatment, the iris tumor completely subsided, and the BCVA improved to 1.0. CONCLUSION: Talaromyces marneffei infection may present as an iris tumor. Metagenome next-generation sequencing is helpful in diagnosis. Oral and topical anti-fungus therapy was sufficient to regress the disease without intraocular injection.

Intravitreal bevacizumab in treatment of iris metastasis from primary lung carcinoma.

Iris metastases secondary to primary malignancy are rare and usually have poor overall survival. We report a case of a man aged 60 years who presented with chief complaints of progressive pain and redness of right eye of 5 days duration. Slit-lamp examination revealed a greyish white irregular nodular mass, arising from anterior iris surface reaching up to mid-periphery. With a clinical suspicion of iris metastasis, systemic investigations were requested. CT scan of chest reported a well-defined lobulated lesion in the lower lobe of lung with presence of multiple satellite nodules in both lungs suggestive of primary malignant neoplasm of lung. Tissue diagnosis was obtained through an iris lesion biopsy, which was opted for relative ease of approach. Histopathology and immunohistochemistry confirmed the diagnosis of iris metastasis secondary to non-keratinising squamous cell carcinoma of lung. Local intravitreal injection of antivascular endothelial growth factor was administered for tumour regression along with systemic chemotherapy.

MANAGEMENT OF METASTATIC BREAST CARCINOMA OF IRIS WITH INTRAOCULAR BEVACIZUMAB INJECTIONS.

PURPOSE: To describe intraocular use of bevacizumab for a metastatic breast carcinoma of the iris resistant to advanced systemic chemotherapy protocols, for which conventional treatment would be local radiotherapy or brachytherapy. METHODS: Case report. RESULTS: A 65-year-old woman, who was previously diagnosed with breast carcinoma and treated with radical mastectomy coupled with radiotherapy and chemotherapy, presented with an iris mass in her left eye. Four successive intravitreal injections of bevacizumab resulted in progressive regression of the tumor to an almost indiscernible size at 8 months, along with blunting of the highly complex tumor vascular network on fluorescein angiography. At 12 months, the patient's visual acuity remained 20/20, and no ocular or systemic adverse effects were encountered. CONCLUSION: Intravitreal bevacizumab can offer a simpler and safer solution to treat metastatic iris tumors compared with other treatment options. This report of bevacizumab for treating iris metastasis from breast carcinoma may broaden the treatment options for similar neoplasms of the iris.

Use of Intravitreal Bevacizumab for the Treatment of Secondary Glaucoma Caused by Metastatic Iris Tumor.

PURPOSE: The purpose of this article was to report the efficacy of intravitreal bevacizumab to resolve secondary angle-closure glaucoma caused by biliary tract carcinoma metastasis to the iris. MATERIALS AND METHODS: A 52-year-old white woman who was under systemic chemotherapy for biliary tract carcinoma presented with a metastatic tumor in the left iris. At presentation, her visual acuity was at the 20/50 level. The tumor was occupying the nasal half of the iris, and had already occupied 5.5 clock hours of the angle, resulting in intraocular pressure elevation to 34 mm Hg. Several small clumps of tumor seeds were also observed on the iris and along the angle. Her intraocular pressure remained high despite full medical therapy with dorzolamide, timolol, brimonidine, and oral acetozolamide. Because of the vascularized nature of the tumor, antivascular endothelial growth factor (anti-VEGF) treatment with 3 repeated injections of bevacizumab (1.25 mg/0.05 mL) was applied 1-month apart. Bevacizumab treatment resulted in an abrupt decrease in tumor mass and disappearance of tumoral seeds from the anterior chamber. The patient's vision improved to 20/20, and intraocular pressure decreased to normal levels. CONCLUSIONS: Anti-VEGF treatment with intravitreal bevacizumab can restore sight and achieve intraocular pressure control in metastatic iris tumors complicated with secondary glaucoma. Anti-VEGF drugs are viable alternatives for the treatment of secondary angle-closure glaucoma induced by metastatic iris tumors and can prevent enucleation of these eyes.

Combined intraocular and systemic rituximab for ocular lymphoproliferative disorder with extranodal marginal zone lymphoma-type morphology after heart transplant.

Post-transplant lymphoproliferative disorder (PTLD) has rarely been associated with ocular manifestations. We report a case of bilateral ocular involvement by PTLD with histopathologic features of extranodal marginal zone (MALT) lymphoma in an 8-year-old boy following orthotopic heart transplantation. The anterior segment disease was treated successfully using a combination of intraocular and systemic injections of humanized anti-CD20 antibody (rituximab).

Topical timolol for an iris hemangioma.

Extraocular infantile hemangiomas have been shown to respond to oral and topical beta blockers, while there is little literature regarding the management of intraocular infantile hemangiomas with beta blockers. This case report discusses the management of an iris hemangioma with topical timolol, a treatment previously unreported in the literature.

Photodynamic Therapy for an iris metastasis from pulmonary adenocarcinoma.

Uveal metastasis is the most common intraocular malignancy. Lung cancer is one of the most common malignancies that metastasize to uvea. Iris involvement is rarely reported. Here we report a case of iris metastasis from pulmonary adenocarcinoma that was treated with photodynamic therapy (PDT). A 65-year-old Chinese man was referred to our hospital for iris white neoplasm and blurred vision for 2 weeks in his right eye. His accepted pulmonary lobectomy, radiotherapy and chemotherapy for pulmonary adenocarcinoma 1year ago and liver metastases were found 2 months earlier. At presentation, anterior segment examination of the right eye showed a hypopigmented, vascularized papillary 3.8 *3.19mm neoplasm located on the temporal iris expanding to 9-clock anterior chamber angle. The patient refused to accept MRI, biopsy and treatment. One week later the tumor grew up to 5.5*7.4mm with diffuse mixed conjunctiva congestion and elevated IOP. A modified PDT was applied. Intravenous verteporfin (3mg/m2) was infused with a 1min bolus. PDT with 3 partly overlapped 5mm laser spots, 689nm (50J/cm2) and 166s were performed 4 minuets later without contact lens. The neo-genesis vessels were occluded with small patch bleeding on the edema tumor that was separated from the anterior chamber angle in the 3days follow-up. PDT may be a safe, noninvasive and psychologically well-accepted treatment for iris metastasis.

INTRAVITREAL BEVACIZUMAB IN THE MANAGEMENT OF BREAST CANCER IRIS METASTASIS.

PURPOSE: To report a case of neovascular and angle closure glaucoma secondary to breast cancer metastatic to the iris that was successfully treated with injections of intravitreal bevacizumab (Avastin) 1.25 mg/0.05 mL. METHODS: Case report. PATIENTS: A 47-year-old woman with metastatic breast cancer presented to The New York Eye Cancer Center with left ocular pain, photosensitivity, vision loss, and multiple iris nodules. Her intraocular pressure was uncontrolled. Gonioscopy revealed neovascularization of the iris and angle; no choroidal neovascularization was noted. Ultrasound biomicroscopy demonstrated tumor invasion of iris stroma with marked anterior uveal thickening and narrowed angles. RESULTS: Three monthly injections of intravitreal bevacizumab resulted in nearly complete resolution of iris neovascularization, reduction of intraocular pressure, and control of tumor (although a small amount of residual tumor remained). CONCLUSION: Intravitreal anti-vascular endothelial growth factor therapy for breast cancer metastatic to the iris with secondary neovascular glaucoma provided good local control for a limited follow-up period, because the patient died because of systemic complications of her disease.

Intravitreal Ranibizumab as Palliative Therapy for Iris Metastasis Complicated With Refractory Secondary Glaucoma.

PURPOSE: To report a case where iris metastasis was the presenting sign of hitherto undiagnosed non-small cell lung carcinoma. The diagnostic approach and patient management are discussed. METHODS: A 51-year-old man presented with pain due to an iris mass and neovascular glaucoma. RESULTS: Systemic evaluation subsequently led to the diagnosis of non-small cell lung carcinoma and the iris mass was considered metastatic. The patient refused any systemic therapy and accepted only intervention for ocular pain relief. Ranibizumab was administered intravitreally and resulted in subsidence of iris mass and new vessels and pain relief, which enhanced the patient's quality of life. CONCLUSIONS: This is the first known report where intravitreal injection of ranibizumab was used as palliative treatment for refractory neovascular glaucoma due to iris metastasis.

[An iris metastasis revealed a bronchopulmonary cancer]. / Métastase irienne révélatrice d'un cancer bronchopulmonaire.

We report the case of a 53-year-old patient referred by his ophthalmologist for a red, painful eye. On exam, he demonstrated findings of granulomatous uveitis with ocular hypertension (38 mm Hg) and a whitish, vascularized iris tumor with invasion of the irido-corneal angle. As our first hypothesis was an iris metastasis, a systemic work-up was carried out, which revealed moderately differentiated broncho-pulmonary carcinoma with multiple metastases (brain, cerebellum and adrenal). Emergency radio-chemotherapy was initiated, and the outcome was good, with rapid regression of the iris metastasis and good efficacy against the primary cancer. After one year of follow-up, the patient developed a metastasis at a new site, and his general condition deteriorated.