Dr Glasson performs rare surgery…

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A rare but important tumour that can occur in the eye is a lesion known as a Leiomyoma. 

This is a small, smooth, muscle tumour similar to the pathology found in the fibroid of the uterus.  We present the case of a 27 year old girl presenting from Tasmania having had a biopsy of a subconjunctival mass in the inferotemporal quadrant of the left eye.  The biopsy showed a choroid Leiomyoma.  Most of the uveal Leiomyomas occur in the ciliary body and the iris.  In the recent Literature Review, 80 of these cases reported over the last 100 years, less than 6% rarely occur within the choroid.

Interestingly, these tumours in the choroid generally grow between the uveal tract and the sclera and in many cases cause significant scleral thinning and, in this particular patient’s case, caused a 4 to 5 mm scleral defect in the eye.  Sometimes these tumours can actually grow endophytically inside the eye causing an amelanotic mass very similar to an amelanotic melanoma.  They  are very difficult to differentiate clinically.  In this case, the tumour grew exophytically protruding from the surface of the eye.  This young girl underwent a surgical resection of the tumour with us being very careful not to cause a defect in the retinochoroidal interface.  Obviously if we tear the retina and having vitreous prolapsing the risk of detachment and long-term visual loss either eye loss is quite high.  In this case the tumour was able to be resected completely and the retinochoroidal interface remained intact and we used a full thickness scleral graft to cover the 5 mm defect in the sclera.  Follow-up pathology confirmed a choroidal Leiomyoma.  The patient is doing well to date, her vision remains normal and currently her retina remains attached.  I present this rare case of ocular choroidal Leiomyoma.

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