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Relative Contraindication of Latanoprost in Iris Tumors with Secondary Glaucoma
Fröhlich S. J., Mueller A. J., Kampik A.,
Ludwig-Maximilians-Universität München, Klinikum Innenstadt, Augenklinik (München)
Purpose: Melanocytic iris tumors are often benign and merely require regular follow-up. Evident growth of its size, increasing pigmentation and secondary glaucoma, however, are possible signs of the tumor`s malignant degeneration.
Patient: We present a 34 years-old male patient showing a localized, mild prominent hyperpigmentation of the right iris expanding over 2 hours. The lesion is known since the patient`s childhood, increasing intraocular pressure (IOP) was treated with timolole, dipivefrin and finally with latanoprost.
Follow-up: 4 years ago, the patient was seen for the first time at our hospital presenting an IOP of 28-30 mm Hg at the concerned right eye. The tumor developed marked heterochromia and a nodular prominent surface. Angle was partly closed and completely hyperpigmented. Ciliary body was uninvolved by the tumor, standardized ultrasound revealed a maximum thickness of 1.2 mm. During the last 4 years, IOP and heterochromia increased without growth of the tumor`s size. Excisional biopsy of the prominent portion was refused by the patient.
Conclusions: The described melanocytic iris tumor shows malignant characteristics like progressive heterochromia and secondary glaucoma. However, increasing iris pigmentation can also be caused by topical application of latanoprost. With the evidence of absent tumor growth, there is no reason to believe in malignant degeneration. Generally, in iris naevi or tumors requiring regular follow-up, application of latanoprost should be avoided in order not to conceal the alteration of pigmentation as possible malignant conversion.