Intraocular Leiomyoma

Intraocular Leiomyoma is a rare, non-cancerous tumor made of smooth muscle cells that grows inside the eye. It most often comes from the uveal tract—the colored part of the eye—especially the ciliary body, but it can also start in the iris or the choroid behind the retina. These tumors grow slowly, rarely spread outside the eye, and most patients are young to middle-aged adults, with women affected about twice as often as men PubMedEyeWiki.

Intraocular leiomyoma is a very rare, non-cancerous (benign) tumor made up of smooth muscle cells that arise inside the eye, most often in the uvea (the pigmented layer beneath the white of the eye) or ciliary body (the part that makes fluid in the eye) PubMed. Under the microscope, it shows tightly packed spindle-shaped cells that stain positive for smooth muscle actin, distinguishing it from more common pigmented tumors like melanoma ScienceDirect. It tends to occur in younger adults (average age ~35 years) with a slight female predominance when in the ciliary body, and can mimic melanoma by presenting as an amelanotic (non-pigmented), firm mass seen on eye exam Nature.

An intraocular leiomyoma is a benign smooth muscle tumor of the eye. “Benign” means it does not invade other tissues or spread to distant organs. Inside the eye, it arises from smooth muscle cells that normally help the iris open and close and control fluid drainage around the lens PubMedEyeWiki.

Under the microscope, these tumors appear as bundles of long, spindle-shaped cells with “cigar-shaped” nuclei and very few dividing cells. They stain positive for smooth muscle markers (actin, desmin) and negative for melanoma markers (HMB-45, S-100), which helps doctors tell them apart from more dangerous tumors like uveal melanoma EyeWiki.

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Types

Intraocular leiomyomas can be classified by their cellular origin and by their location:

1. Mesectodermal leiomyomas

   • Originate from neural crest–derived smooth muscle in the iris sphincter or dilator muscles.

   • Show both muscle and nerve features under special stains EyeWiki.

2. Mesodermal leiomyomas

   • Arise from smooth muscle cells around blood vessels in the uveal tract.

   • Share features with smooth muscle tumors elsewhere in the body EyeWiki.

3. By location:

   • Iris leiomyoma – in the colored front part of the eye.

   • Ciliary body leiomyoma – in the ring of tissue that makes fluid and holds the lens.

   • Choroidal leiomyoma – in the layer behind the retina.
     The ciliary body is most often involved, followed by the iris, with choroidal tumors being the rarest EyeWiki+1.

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Possible Causes & Contributing Factors

The true cause of intraocular leiomyoma is not known. Most cases seem to happen by chance, without clear risk factors. However, experts have proposed several possible contributing factors:

1. Smooth muscle cell overgrowth
   An abnormal trigger makes smooth muscle cells multiply too much. EyeWiki

2. Neural crest cell mis‐differentiation
   Some iris muscle cells arise from early nerve tissue (neural crest), which may behave differently. EyeWiki

3. Vascular smooth muscle proliferation
   Muscle cells around eye blood vessels may turn into a tumor. EyeWiki

4. Hormonal influences
   Many tumors have estrogen and progesterone receptors, suggesting hormones may play a role. EyeWiki

5. Genetic mutations
   Changes in genes that control muscle cell growth might trigger a tumor. NCBI

6. Chronic inflammation
   Long-standing uveitis or other eye inflammation could stimulate muscle cell growth. WebEye

7. Trauma or surgery
   Injury or prior surgery to the eye might lead to abnormal healing and tumor formation. WebEye

8. Embryonic cell rests
   Tiny bits of muscle-forming tissue left over from development may later turn into a tumor. EyeWiki

9. Hormone receptor dysregulation
   Overactive hormone signals in smooth muscle cells could push them to grow. EyeWiki

10. Local growth factors
    Abnormal levels of proteins that encourage cell growth might be involved. PubMed

11. Oxidative stress
    Damage from free radicals in eye tissues may trigger cell changes. PubMed

12. Autoimmune reactions
    The immune system might accidentally target muscle cells, causing repair and overgrowth. WebEye

13. Age‐related changes
    Most tumors occur in adults 30–40 years old; cell aging processes might play a role. PubMed

14. Female sex predilection
    Women have about double the risk, possibly due to estrogen effects. EyeWiki

15. Pregnancy
    Hormone changes during pregnancy might fuel tumor growth in rare cases. WebEye

16. Systemic leiomyomas
    A few patients with uterine fibroids also develop eye leiomyomas, hinting at shared causes. PubMed

17. Environmental toxins
    Exposure to certain chemicals could damage DNA in smooth muscle cells. PubMed

18. Viral infections
    Some viruses can insert genes into host cells and cause tumors (hypothetical). NCBI

19. Epigenetic changes
    Chemical modifications of DNA that do not change the gene sequence might switch on growth genes. PubMed

20. Unknown sporadic events
    In most patients, no clear cause is found, and the tumor appears “out of the blue.” EyeWiki

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Common Symptoms

Because these tumors grow slowly, many people have no symptoms until the tumor is large enough to interfere with vision or eye structures:

1. Blurred vision – images look fuzzy or out of focus WebEye

2. Flashing lights (photopsia) – seeing flashes when you move your eyes WebEye

3. Floaters – small spots or threads drifting across your vision WebEye

4. Eye pain – aching or sharp pain, especially if the tumor presses on structures WebEye

5. Light sensitivity (photophobia) – bright lights feel uncomfortable EyeWiki

6. Glare – seeing halos or rings around lights EyeWiki

7. No symptoms (asymptomatic) – often found by chance on an eye exam EyeWiki

8. Sudden eyelid swelling – rare acute presentation with puffiness around the eye EyeWiki

9. Severe vision loss – vision may drop to only perceiving light in advanced cases EyeWiki

10. Secondary glaucoma – high eye pressure causes halos, vision changes, and pain WebEye

11. Exudative retinal detachment – fluid under the retina blurs vision sharply WebEye

12. Retinal detachment (secondary) – the retina peels away, causing flashing lights and floaters ScienceDirect

13. Macular edema – swelling at the central retina causes distorted vision ScienceDirect

14. Lens subluxation – the lens shifts position, leading to blurred or double vision WebEye

15. Visual field defects – patches of vision loss from mass effect EyeWiki

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 Diagnostic Tests

Diagnosing intraocular leiomyoma requires combining clinical exams, lab tests, and imaging to rule out melanoma and other eye tumors.

A. Physical Exam

1. Visual acuity – measures how clearly you see at different distances WebEye

2. Pupillary reaction – checks if pupils constrict normally in light WebEye

3. Intraocular pressure (tonometry) – detects high pressure from glaucoma WebEye

4. Slit-lamp exam – uses a bright microscope to view the front structures of the eye EyeWiki

B. Manual Test

5. Gonioscopy – places a special lens on the eye to look at fluid-drainage channels EyeWiki

C. Laboratory & Pathological Studies

6. Fine-needle aspiration biopsy (FNAB) – a thin needle samples cells from the tumor WebEye

7. Histopathology (H&E stain) – examines cell shape and arrangement under a microscope EyeWiki

8. Immunohistochemistry for SMA/desmin – confirms smooth muscle origin EyeWiki

9. Marker staining (S-100, HMB-45) – excludes melanoma by showing these markers are negative EyeWiki

10. Electron microscopy – sees ultra-fine cell structures when needed WebEye

D. Electrodiagnostic Tests

11. Electroretinography (ERG) – measures retinal cell responses to light EyeWiki

12. Electrooculography (EOG) – assesses the health of the retinal pigment epithelium EyeWiki

13. Visual evoked potentials (VEP) – records brain responses to visual stimuli EyeWiki

E. Imaging

14. Ultrasound biomicroscopy (UBM) – high-frequency ultrasound to view the tumor’s extent EyeWiki

15. B-scan ultrasonography – shows the tumor’s size and internal reflectivity PubMed

16. Optical coherence tomography (OCT) – cross-sectional images of retina and tumor surface EyeWiki

17. Fluorescein angiography (FA) – dye injected to highlight blood flow around the tumor EyeWiki

18. Indocyanine green angiography (ICG) – deeper blood vessel imaging for choroidal tumors EyeWiki

19. Magnetic resonance imaging (MRI) – detailed soft-tissue images of the eye and orbit WebEye

20. Computed tomography (CT) – picks up calcifications and bone changes near the tumor WebEye

Non-Pharmacological Treatments

1. Observation and Regular Monitoring
   Simply watching the tumor over time with scheduled exams can be safe for very small, asymptomatic lesions, reducing unnecessary interventions. The mechanism is early detection of growth before vision is threatened PubMed.

2. Ultrasound Biomicroscopy
   High-frequency ultrasound captures detailed images of small tumors in the iris or ciliary body. Purpose: track size and internal reflectivity. Mechanism: sound waves reflect differently off solid tumors versus normal tissue WebEye.

3. Optical Coherence Tomography (OCT)
   OCT uses light waves to produce cross-sectional images of the retina and uvea. Purpose: monitor tumor thickness and effects on adjacent structures. Mechanism: light reflection differences between tumor and healthy tissue.

4. Fundus Photography
   Standardized color photos document tumor appearance over time. Purpose: detect subtle changes in color or borders. Mechanism: reproducible imaging of the back of the eye.

5. Visual Field Testing
   Automated perimetry checks for areas of vision loss that might indicate tumor pressure on adjacent retina. Mechanism: measures differential light sensitivity across the visual field.

6. Argon Laser Photocoagulation
   Laser beams create small burns around or within the tumor to induce scarring and shrinkage. Purpose: reduce tumor blood supply. Mechanism: heat-induced coagulation of tumor vessels PMC.

7. Photodynamic Therapy (PDT)
   A light-activated drug is injected, then activated with a low-power laser to produce reactive oxygen species that destroy tumor cells. Purpose: selective tumor cell killing. Mechanism: photosensitizer-mediated cytotoxicity.

8. Cryotherapy
   Extreme cold is applied via a probe to freeze and kill tumor cells. Purpose: destroy small, peripheral tumors. Mechanism: ice crystal formation disrupts cell membranes PMC.

9. Transpupillary Thermotherapy (TTT)
   Infrared laser heats the tumor through the pupil to 45–60 °C, inducing protein denaturation and cell death. Purpose: treat small to medium lesions. Mechanism: hyperthermia‐mediated coagulation of tumor tissue.

10. Plaque Brachytherapy
    A radioactive implant (“plaque”) is sutured to the sclera over the tumor for several days. Purpose: deliver localized radiation. Mechanism: ionizing radiation damages DNA in tumor cells ScienceDirect.

11. External Beam Radiotherapy
    Focused beams target the tumor from outside the eye. Purpose: treat larger or inaccessible lesions. Mechanism: radiation-induced DNA damage in dividing cells ScienceDirect.

12. Proton Beam Therapy
    Uses protons instead of photons for more precise dose deposition. Purpose: spare healthy retina. Mechanism: Bragg peak effect deposits energy primarily in tumor.

13. Stereotactic Radiosurgery (Gamma Knife)
    Delivers a high single dose of radiation from multiple angles. Purpose: treat small tumors in a single session. Mechanism: converging beams produce lethal dose at tumor.

14. Fine Needle Aspiration Biopsy (FNA)
    A tiny needle removes cells for diagnosis and may partially debulk small tumors. Mechanism: mechanical disruption and sampling.

15. Endoresection
    Surgical removal of tumor from inside the eye via vitrectomy instruments, typically after pre-operative radiation. Purpose: preserve the globe. Mechanism: mechanical excision of tumor tissue.

16. Low-Vision Rehabilitation
    Training with devices (magnifiers, telescopic lenses) to optimize remaining vision. Purpose: improve quality of life. Mechanism: adaptation and assistive devices.

17. Psychological Counseling
    Emotional support for coping with vision changes and treatment stress. Mechanism: mental health therapy to reduce anxiety and depression.

18. Protective Eyewear
    Sunglasses that block UV light may protect overall ocular health, though not specific to leiomyoma. Mechanism: UV filtration to reduce additional ocular damage.

19. Occupational Therapy
    Training to adjust tasks at work or home to compensate for visual deficits. Mechanism: skill re-training for daily activities.

20. Support Group Participation
    Connecting with others facing eye tumors for shared experiences. Mechanism: peer support reduces isolation.

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Drug Treatments

Note: No drugs are specifically approved for intraocular leiomyoma; the following are off-label or inferential therapies based on uterine leiomyoma and ocular tumor literature.

1. Leuprolide Acetate (GnRH Agonist)

   • Class: Gonadotropin-Releasing Hormone (GnRH) agonist

   • Dosage & Time: 3.75 mg intramuscularly every 4 weeks for up to 24 weeks

   • Purpose: Shrink smooth muscle tumors by reducing estrogen levels

   • Mechanism: Downregulates pituitary GnRH receptors → decreased FSH/LH → hypoestrogenism PubMed

   • Side Effects: Hot flashes, bone density loss, vaginal dryness

2. Ulipristal Acetate

   • Class: Selective Progesterone Receptor Modulator (SPRM)

   • Dosage & Time: 5 mg orally once daily for 3 months (as per uterine fibroid use)

   • Purpose: Reduce tumor size and bleeding

   • Mechanism: Blocks progesterone receptors on smooth muscle cells Wikipedia

   • Side Effects: Headache, nausea, possible liver enzyme changes

3. Letrozole

   • Class: Aromatase inhibitor

   • Dosage & Time: 2.5 mg orally once daily for 3 months

   • Purpose: Lower estrogen production to inhibit tumor growth

   • Mechanism: Inhibits aromatase enzyme → reduced peripheral estrogen synthesis PMC

   • Side Effects: Bone loss, joint pain

4. Tamoxifen

   • Class: Selective Estrogen Receptor Modulator (SERM)

   • Dosage & Time: 20 mg orally once daily

   • Purpose: Block estrogen-driven proliferation

   • Mechanism: Antagonizes estrogen receptors in smooth muscle cells

   • Side Effects: Risk of blood clots, endometrial changes

5. Mifepristone

   • Class: Progesterone receptor antagonist

   • Dosage & Time: 10 mg orally once daily for up to 3 months

   • Purpose: Tumor shrinkage in hormone-dependent leiomyomas

   • Mechanism: Blocks progesterone signaling Nature

   • Side Effects: Fatigue, headache

6. Medroxyprogesterone Acetate

   • Class: Progestin

   • Dosage & Time: 10 mg orally once daily

   • Purpose: Modulate hormone environment

   • Mechanism: Alters estrogen/progesterone balance in target tissue

   • Side Effects: Weight gain, mood changes

7. Bevacizumab (Avastin)

   • Class: Anti-VEGF monoclonal antibody

   • Dosage & Time: 1.25 mg intravitreal injection once every 4–6 weeks

   • Purpose: Reduce tumor vascularity

   • Mechanism: Neutralizes VEGF → inhibits new blood vessel growth ResearchGate

   • Side Effects: Eye irritation, rare endophthalmitis

8. Ranibizumab (Lucentis)

   • Class: Anti-VEGF

   • Dosage & Time: 0.5 mg intravitreal monthly

   • Purpose & Mechanism: Similar to bevacizumab

   • Side Effects: Similar to bevacizumab

9. Pegaptanib (Macugen)

   • Class: Anti-VEGF aptamer

   • Dosage & Time: 0.3 mg intravitreal every 6 weeks

   • Purpose: Targeted VEGF inhibition in ocular tumors

   • Side Effects: Ocular discomfort

10. Interferon-α (IFN-α)

• Class: Immunotherapy cytokine

• Dosage & Time: 1 million IU intravitreal weekly for 4–6 weeks

• Purpose: Anti-proliferative, immunomodulatory

• Mechanism: Activates immune pathways to inhibit tumor cells

• Side Effects: Intraocular inflammation, floaters

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Dietary Molecular & Herbal Supplements

Based on uterine leiomyoma studies; no direct intraocular evidence exists.

1. Curcumin (Turmeric Extract)

   • Dosage: 500 mg twice daily

   • Function: Anti-proliferative

   • Mechanism: Activates PPARγ, induces apoptosis in leiomyoma cells PubMed

2. EGCG (Epigallocatechin Gallate, Green Tea Extract)

   • Dosage: 800 mg daily (45% EGCG)

   • Function: Anti-angiogenic, anti-fibrotic

   • Mechanism: Inhibits NF-κB & VEGF pathways PMC

3. Resveratrol

   • Dosage: 200 mg daily

   • Function: Anti-fibrotic, antiproliferative

   • Mechanism: Reduces ECM protein expression in leiomyoma cells PMCMDPI

4. Vitamin D₃ (Cholecalciferol)

   • Dosage: 1,000 IU daily

   • Function: Hormone regulation

   • Mechanism: Low serum levels correlate with fibroid risk Wikipedia

5. Genistein (Soy Isoflavone)

   • Dosage: 50 mg twice daily

   • Function: Modulates estrogen receptors

   • Mechanism: Weak estrogenic/anti-estrogenic action

6. Indole-3-Carbinol (I3C)

   • Dosage: 200 mg daily

   • Function: Detoxification support

   • Mechanism: Modifies estrogen metabolism in liver

7. Diindolylmethane (DIM)

   • Dosage: 100 mg daily

   • Function: Estrogen balance

   • Mechanism: Promotes favorable estrogen metabolite ratios

8. Quercetin

   • Dosage: 500 mg daily

   • Function: Antioxidant, anti-inflammatory

   • Mechanism: Inhibits pro-inflammatory cytokines

9. Silymarin (Milk Thistle Extract)

   • Dosage: 200 mg twice daily

   • Function: Liver support, antioxidant

   • Mechanism: Scavenges free radicals

10. Lycopene

    • Dosage: 10 mg daily

    • Function: Antioxidant

    • Mechanism: Inhibits cell proliferation

11. Omega-3 Fatty Acids (Fish Oil)

    • Dosage: 1 g EPA/DHA daily

    • Function: Anti-inflammatory

    • Mechanism: Modulates eicosanoid pathways

12. Melatonin

    • Dosage: 3 mg nightly

    • Function: Antioxidant

    • Mechanism: Scavenges reactive oxygen species

13. Vitamin E (α-Tocopherol)

    • Dosage: 400 IU daily

    • Function: Antioxidant

    • Mechanism: Prevents lipid peroxidation

14. Selenium

    • Dosage: 200 µg daily

    • Function: Antioxidant enzyme cofactor

    • Mechanism: Supports glutathione peroxidase

15. Zinc

    • Dosage: 15 mg daily

    • Function: Immune support

    • Mechanism: Cofactor for many enzymes

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Regenerative & Stem-Cell-Related Drugs

1. Sirolimus (Rapamycin)

   • Dosage: 2 mg orally once daily

   • Function: mTOR inhibitor, anti-proliferative

   • Mechanism: Blocks cell cycle progression

2. Everolimus

   • Dosage: 10 mg orally once daily

   • Function: mTOR inhibition

   • Mechanism: Similar to sirolimus

3. Temsirolimus

   • Dosage: 25 mg IV weekly

   • Function: mTOR inhibitor

   • Mechanism: Reduces protein synthesis in tumor cells

4. Interleukin-2 (Aldesleukin)

   • Dosage: 600,000 IU subcutaneously daily for 5 days

   • Function: Immune activation

   • Mechanism: Stimulates T-cell and NK cell proliferation

5. Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF)

   • Dosage: 250 µg/m² subcutaneously daily for 5 days

   • Function: Immune regeneration

   • Mechanism: Promotes maturation of immune cells

6. Autologous Mesenchymal Stem Cell (MSC) Injection

   • Dose: ~1×10⁶ cells intravitreal (investigational)

   • Function: Tissue repair, anti-inflammatory

   • Mechanism: Paracrine release of growth factors

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 Surgeries

1. Iris Iridectomy

   • Procedure: Partial removal of iris tissue where tumor is located

   • Why: Excise small iris leiomyomas while preserving eye integrity Nature.

2. Iridocyclectomy

   • Procedure: Removal of iris plus adjacent ciliary body tumor via scleral flap

   • Why: Remove medium-sized ciliary body leiomyoma while sparing globe BioMed Central.

3. Partial Lamellar Sclerouvectomy

   • Procedure: Scleral flap and removal of choroidal/ciliary tumor

   • Why: Excise deep uveal tumor while maintaining globe.

4. Endoresection

   • Procedure: Vitreoretinal surgery to resect tumor from inside the eye

   • Why: Globe-salvage approach for select choroidal tumors.

5. Enucleation

   • Procedure: Complete removal of the eyeball

   • Why: Indicated for very large tumors, uncertain diagnosis, or when vision cannot be preserved Nature.

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 Prevention Strategies

Note: No specific prevention is known due to unclear causes EyeWiki. These general eye-health measures may help:

1. Regular comprehensive eye exams

2. UV-blocking sunglasses

3. Healthy weight maintenance

4. Balanced diet rich in fruits and vegetables

5. Vitamin D sufficiency (≥30 ng/mL serum level)

6. Antioxidant-rich foods (berries, green tea)

7. Avoidance of smoking and excessive alcohol

8. Control of systemic conditions (hypertension, diabetes)

9. Stress management and sleep hygiene

10. Protective eyewear during sports or hazardous work

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When to See a Doctor

• New, unexplained change in eye color or shape of pupil

• Blurred vision, visual field loss, or flashes of light

• A visible white or yellow mass in the iris or pupil

• Eye pain or discomfort not explained by dry eye

• Redness or inflammation around the tumor

• Sudden increase in floaters

• Raised intraocular pressure (detected on exam)

• Significant tumor growth on monitoring

• Suspected spread to surrounding structures

• Planning treatment consultation for tumor management

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 Foods to Eat and Avoid

Eat:

1. Leafy greens (spinach, kale) – antioxidants EatingWell

2. Berries (blueberries, strawberries) – flavonoids

3. Nuts (almonds, walnuts) – healthy fats

4. Fatty fish (salmon, mackerel) – omega-3s

5. Green tea – EGCG PMC

6. Turmeric-seasoned dishes – curcumin PubMed

7. Citrus fruits – vitamin C

8. Beans and legumes – fiber, phytoestrogens

9. Whole grains – stable blood sugar

10. Low-fat dairy or fortified plant milks – vitamin D

Avoid:

1. Red and processed meats – pro-inflammatory EatingWell

2. Excessive caffeine – may affect hormone balance

3. Alcohol – oxidative stress

4. High-fat dairy – unclear effects on smooth muscle tumors

5. Refined sugars – feed inflammation

6. Trans fats (fried foods) – inflammation

7. Excess salt – may worsen pressure changes in eye

8. Smoking – vascular damage

9. Artificial additives – potential endocrine disruptors

10. Plastics with phthalates – possible hormonal effects

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Frequently Asked Questions

1. What is an intraocular leiomyoma?
   A benign smooth muscle tumor inside the eye, often in the iris or ciliary body PubMed.

2. How common is it?
   Extremely rare—around 80 reported cases in the literature ResearchGate.

3. What causes it?
   Unknown; may arise sporadically from uveal smooth muscle or vessel walls WebEye.

4. Is it cancerous?
   No, it is benign and does not metastasize.

5. How is it diagnosed?
   Eye exams with slit lamp, ultrasound biomicroscopy, OCT, and often biopsy with immunohistochemistry WebEye.

6. What are the symptoms?
   Blurred vision, visible pupil mass, ocular discomfort, sometimes none.

7. Can it turn into melanoma?
   No, but it can mimic melanoma clinically, so biopsy is important ScienceDirect.

8. What imaging tests are used?
   Ultrasound, OCT, fundus photography, fluorescein angiography.

9. What is the first-line treatment?
   Depends on size/location—small asymptomatic tumors often monitored; others treated with laser, radiation, or surgery PMC.

10. Is surgery always needed?
    Not always—many can be managed non-surgically if small and stable.

11. What are the risks of treatment?
    Vision loss, cataract, glaucoma, inflammation, but many treatments spare the globe.

12. Can it recur?
    Recurrence is rare if completely excised.

13. Are there known preventive measures?
    None specific; general eye health measures recommended EyeWiki.

14. What is the prognosis?
    Excellent if managed appropriately; most patients retain vision and avoid eye removal.

15. Where can I get more information?
    Consult an ocular oncologist; resources include EyeWiki and peer-reviewed ophthalmology journals EyeWiki.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: August 07, 2025.

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