Iridocyclectomy for neovascular glaucoma caused by proton-beam radiotherapy of pigmented ciliary adenocarcinoma.
OBJECTIVE
To report neovascular glaucoma after proton-beam radiotherapy of an adenocarcinoma of the pigmented ciliary epithelium and its successful treatment by iridocyclectomy.


METHODS
A 65-year-old man developed neovascular glaucoma 10 months after proton-beam radiotherapy of a small pigmented iridociliary tumour with a clinical differential diagnosis of uveal melanoma or adenocarcinoma. The diagnosis of 'toxic tumour syndrome' was made, and iridocyclectomy performed.


RESULTS
Histopathology and immunohistochemistry of the specimen diagnosed an adenocarcinoma of the pigmented ciliary epithelium, with the presence of mitoses suggesting residual viable tumour cells. The rubeosis regressed, with normalization of the intraocular pressure. Phacoemulsification for radiation-induced cataract restored VA to 6/9, which was better than that recorded at initial referral, the patient having longstanding cellophane maculopathy.


CONCLUSIONS
Neovascular glaucoma after radiotherapy of a small, pigmented, ciliary body tumour raises the possibility of adenocarcinoma. This 'toxic tumour syndrome' may respond to iridocyclectomy of the irradiated tumour.
Schalenbourg
Ann
A
St. Paul's Eye Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK. ann.schalenbourg@ophtal.vol.ch
Coupland
Sarah
S
Kacperek
Andrzej
A
Damato
Bertil
B
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D000368:Aged; D002924:Ciliary Body / Q000000981:diagnostic imaging / Q000473:pathology / Q000528:radiation effects*; D015355:Glaucoma, Neovascular / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D032801:Iridectomy; D007498:Iris / Q000601:surgery; D008297:Male; D018918:Phacoemulsification; D011832:Radiation Injuries / Q000209:etiology / Q000601:surgery*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D014463:Ultrasonography; D014604:Uveal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D014792:Visual Acuity