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Editor,—Haemangiomas of the uveal tract are most frequently located in the choroid. Diffuse choroidal haemangiomas are seen generally in patients with Sturge–Weber syndrome (encephalofacial haemangiomatosis).1 Haemangiomas of the ciliary body are extremely rare.2 Haemangiomas of the iris are also rare, with an incidence of 2% in a series of 145 primary tumours of the iris.3
Leprosy is a chronic granulomatous disease caused byMycobacterium leprae. A number of tumours have been reported in leprosy patients, some associated with the complications produced by the disease and some incidental.4-6 We report here an iris haemangioma that occurred in a leprosy patient.
A 45-year-old man presented in the eye clinic of the Schieffelin Leprosy Research and Training Centre in July 1993 with complaints of watering and pain in the left eye for 1 month. There was no history of any injury to the eye. The patient was diagnosed to have borderline tuberculoid (BT) leprosy 27 years ago. He was treated with dapsone monotherapy for 7 years and also with a 6 month course of the multidrug therapy as recommended by the WHO.7 He was released from antileprosy treatment 3 years ago.
On examination, the right eye had lagophthalmos and an immature, age-related cataract. The left eye also had lagophthalmos, the conjunctiva being chemotic. There was dense white slough and thinning of the central cornea with iris pigment tamponading a potential perforation. The corrected visual acuity was 6/12 in the right eye and hand movements (HM) in the left eye. The routine skin smears for acid fast bacilli were negative. Smears taken from the corneal slough did not reveal any bacterial or fungal organisms on microscopic examination. The patient was treated with hourly antifungal and antibiotic topical drops but the condition in the left eye continued to worsen and ultimately ended in complete prolapse of the iris. Since there was no perception of light in the left eye and most of the contents were extruded outside, the eye was eviscerated at the patient’s request. Swabs immersed in the eviscerated contents were sent for aerobic and anaerobic culture and sensitivity but turned out to be negative for organisms. The eviscerated contents were also sent for histopathological examination.
The histopathological examination showed dense inflammatory exudates composed of neutrophils, lymphocytes, and a few eosinophils in the epithelium as well as in the substantia propria of the corneal tissue. Fragments of iris tissue showed a benign tumour composed of many thin walled cavernous blood vessels and spaces lined by endothelial cells separated by scanty connective tissue stroma8 (Figs 1 and2). These proliferating vessels were also found among the smooth muscle fibres of the iris (Fig 3). The surrounding stroma showed a few scattered cells containing melanin pigment. In sections the iris was seen to be adherent to the conjunctiva which showed fibrosis. The nerves of the iris were not inflamed. Sections of lens, choroid, and retinal fragments did not show any significant inflammation. An exhaustive search for acid fast bacilli was negative, as was to be expected in a borderline tuberculoid leprosy patient.
This benign tumour was an accidental discovery in the eviscerated ocular contents of this patient. Although it was present in a patient who had leprosy, the finding is not related to the disease. The patient did not demonstrate any of the syndromes associated with haemangiomas and the anterior and posterior ocular segments of the other eye did not show any abnormal features associated to the finding in the eviscerated eye.
Since haemangiomas of the iris are rare the probability that a prominently vascularised tumour of the iris is a true haemangioma is low.9 There are few histopathologically proved iris haemangiomas.10 Even those that have been histopathologically reported as iris haemangiomas have on re-examination and further sectioning proved to be juvenile xanthogranulomas11 and malignant melanomas,12and the validity of the diagnosis of some reported haemangiomas have been questioned.9 Haemangiomas of the uveal tissue are most frequently located in the choroid. In this patient the choroid tissue was normal and did not demonstrate any tumour. Clinically and histopathologically there was no evidence of juvenile xanthogranuloma or malignant melanoma. The cavernous nature of the haemangioma rules out a pyogenic source.
This histopathological study showing many thin walled blood channels just below the iris epithelium and clearly demonstrating the presence of these blood vessels amidst the smooth muscle fibres of the iris establishes that the haemangioma is from the iris. Since the tumour is rare and its histopathological demonstration scarce we have reported this finding.