Case report EJO European Journal of Ophthalmology Trabeculectomy in an unsuspected extramedullary iris–ciliary body plasmacytoma Harathy Selvan 1 , Seema Kashyap 2 , Seema Sen 2 , Bhavna Chawla 1 , Neiwete Lomi 1 and Viney Gupta 1 Abstract Extramedullary plasmacytoma of the iris and ciliary body is extremely rare. We present a case which was misdiagnosed as granulomatous uveitis with neovascular glaucoma, and underwent a trabeculectomy with mitomycin-c along with iris biopsy. The post-operative period showed early bleb failure and catastrophic growth of the suspected mass. Histopathological examination revealed a diagnosis iris plasmacytoma. Subsequent ultrasound biomicroscopy showed involvement of the iris and ciliary body. A prompt systemic workup was done, and an associated systemic plasma cell dyscrasia was ruled out. The affected eye was enucleated, and the patient remains disease free at the end of 3-year follow-up. Keywords Extramedullary plasmacytoma, iris–ciliary body plasmacytoma, neovascular glaucoma, iris granuloma Date received: 12 September 2019; accepted: 27 March 2020 Introduction Plasmacytoma is a neoplasm of plasma cell origin. They are commonly encountered secondary to systemic mul- tiple myeloma. 1 Rarely, they may present as solitary lesions involving the bones or extramedullary tissues. Primary extramedullary plasmacytomas are infrequent, and constitute only 3% of plasma cell tumours overall. 2 Orbital and ocular plasmacytomas are rare. They mostly occur in the setting of systemic disease or may be a harbinger of impending disease. 1,3,4 There are very few reports of uveal plasmacytomas in the litera- ture, 1,5–10 most of which are in conjunction with sys- temic plasma cell dyscrasias. To the best of our knowledge, there are only two reports of primary extra- medullary iris–ciliary body plasmacytoma. 7,8 We present a case of unsuspected iris–ciliary body plasma- cytoma that mimicked granulomatous uveitis with neo- vascular glaucoma, raising diagnostic difficulties and offering learning lessons. Case report A 59-year-old male presented to the outpatient depart- ment with complaints of occasional redness in the left eye (LE) for 4 months. There was no known systemic illness, but contact history for tuberculosis (TB) was positive. The best corrected visual acuity was 6/6 in the right eye (RE) and 6/9 in the LE. On slit lamp biomicroscopy, the LE showed mutton-fat keratic pre- cipitates, cells 2þ, flare 2þ, an inferonasal boggy iris mass with localised rubeosis iridis, peripheral anterior and posterior synechiae along with a sectoral cataract (Figure 1). On þ90 D fundus evaluation, LE showed glaucomatous cupping with a cup–disc ratio (CDR) 0.9:1 and pale neuroretinal rim. The rest of the fundus was within normal limits; there were no signs of intermediate or posterior uveitis. The RE was within 1 Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India 2 Department of Ocular Pathology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India Corresponding author: Harathy Selvan, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room No. 494, 4th floor, New Delhi 110029, India. Email: sharathy2012@gmail.com European Journal of Ophthalmology 0(0) 1–4 ! The Author(s) 2020 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1120672120920225 journals.sagepub.com/home/ejo