Buphtalmie secondaire à un kyste congénital de l’épithélium pigmentaire de l’iris

Detection of an Iris Pigmented Epithelium Cyst in a Child by High Frequency Ultrasonography

An 18-month-old boy presented with an iris pigmented epithelium cyst. The diagnosis was confirmed using high frequency ultrasonography. The cyst was determined to be in an intermediate location, thus needing no treatment provided that any potential complications were noted. However, continued monitoring is required to detect any changes to adapt management. [J Pediatr Ophthalmol Strabismus. 2017;54:e31-e33.].

Amblyopia secondary to iris cyst

CLINICAL CASE

A 5 year-old child diagnosed with moderate anisometropic amblyopia secondary to primary cyst of iris pigment epithelium. He was evaluated with ultrasound biomicroscopy (BMU) and optical coherence tomography (OCT) of anterior segment.

DISCUSSION

The OCT, although with some limitations, is a useful tool to study the anterior segment. It is probably more recommendable than BMU in the childhood.

Ultrasound biomicroscopic evaluation of anterior segment cysts as a risk factor for ocular hypertension and closure angle glaucoma

AIM

To investigate the relationship between the ultrasound biomicroscopic (UBM) features of anterior-segment cysts (ASCs) and increased intraocular pressure (IOP) as a risk factor for closed-angle glaucoma (CAG).

METHODS

Totally 24 eyes with recently diagnosed ASCs were divided into two groups. First group with ASC and ocular normotension (n=13), second group with ASC and ocular hypertension (n=11). An ophthalmologic examination, including tonometry, slit-lamp biomicroscopy (SLBM), gonioscopy, fundoscopy, pentacam, and UBM, was performed. The features of the ASCs were compared with the IOP.

RESULTS

ASCs were accurately diagnosed and delineated in 24 eyes using UBM. IOP was elevated in those ASCs with a secondary aetiology (P=0.027), iridociliary location (P=0.006), deformed shape (P=0.013), increased size (P=0.001) and elongated pupillary aperture (P=0.009). However, the count (P=0.343) of ASCs, anterior chamber depth (ACD; P=0.22) and axial lenght (AL; P=0.31) were not associated with ocular hypertension. Correlations were found between the IOP and ASC size (r=-0.712; P=0.003), anterior chamber angle (ACA; r=-0.985; P<0.001), angle opening area (AOA; r=0.885; P<0.001), angulation of iris (r=-0.776, P<0.001), and affected iris quadrant (r =-0.655, P=0.002).

CONCLUSION

Ocular hypertension in some eyes with ASC might be associated with various mechanisms, including secondary aetiology, iridociliary location, deformed shape, increased size and elongated pupill, which can be determined by UBM.

Iris cysts: a review

Iris cysts though uncommon, present diagnostic and therapeutic challenges. With the advent of better investigational modalities it is not so difficult to characterize iris cysts and differentiate them from uveal tumors. Management strategies however, are still not clearly defined and long term course especially of inclusion cysts of the iris remains dismal. In this review we present the classification, pathogenesis, differential diagnosis and management options along with long term clinical course of eyes with iris cysts.

Ultrabiomicroscopie et physiopathologie des kystes iriens congénitaux

AIMS

Iris epithelial cysts, congenital or acquired, are rare tumors of the anterior chamber. The use of ultrasound biomicroscopy (UBM) and high-resolution echography (50 MHz) specified the diagnosis and confirmed the developmental hypothesis.

METHODS

UBM examination with general anesthesia can provide very good vision of cysts and iris structure similar to histological examination. Successive slices are systematically produced. We report two cases: one in a 3-month-old boy with a pupillary type of pigment epithelial cyst and one in a 23-month-old boy with stromal iris cyst provides new information on iris cysts.

RESULTS

UBM can clearly differentiate two types of cyst, with results similar to histological slice examination. UBM slices of iris edge cysts show small cellular parietal groups with stromal echogenicity, with no visible tissular continuity. The stromal cyst has no particularity and no echogenicity.

DISCUSSION

The pupillary type of pigment epithelial cyst was generally recognized very early. The great majority of primary iris cysts, particularly those that arise from the iris pigment epithelial layers, are stable lesions that rarely progress or cause visual complications. Their slow progression could be explained by embryological history. Based on a comparison between the aspects of the two observations, the absence of enlargement of the cyst could be explained by the developmental mechanism.

CONCLUSION

The advantage of the UBM in diagnosis is confirmed for very young patients, but also in developmental investigations. These case reports also corroborate the migration cellular theory during eye development to explain the appearance of the pupillary type of pigment epithelial cyst.