Multiple bilateral primary cysts of the iris pigment epithelium

A Case of Annular Iris Cyst Diagnosed With the Help of Ultrasound Biomicroscopy

PURPOSE

To report a case of annular iris cyst presenting as a secondary angle closure managed with Nd:YAG laser iridotomy.

DESIGN

Case report.

METHODS

Institutional review board exemption for this case report was obtained from the institutional ethics committee, Aravind eye hospital, Tirunelveli. All research adhered to the tenets of the Declaration of Helsinki. Informed consent was obtained.A 45-year-old woman presented with a 2-week history of sudden onset of pain and redness in the right eye. Slit-lamp biomicroscopy showed corneal edema, with the shallow anterior chamber, convex bowing of iris, irregular shape of the pupil, and glaucomflecken on the clear lens. Ultrasound biomicroscopy revealed an annular iris cyst of the iris pigment epithelium. Nd:YAG laser iridotomy was done to drain the cyst and relieve the angle closure.

RESULTS

Laser treatment resulted in the collapse of the cyst, confirmed by ultrasound biomicroscopy and disappearance of the subject symptoms.

CONCLUSION

Iris cysts are usually benign in nature. An annular iris cyst is a rare presentation. They can present with a secondary angle closure as in our report. Correct diagnosis and timely intervention bring about a desirable result. With this report, the authors aim to catalog and familiarize ophthalmologists with a rare ocular pathology and its management.

Iris cysts: A comprehensive review on diagnosis and treatment

Iris cysts, both primary and secondary, are a diagnostic and treatment challenge. Primary cysts arise either from the iris pigment epithelium or the iris stroma. Posterior pigment epithelial cysts are subdivided according to their location as central, midzonal, and peripheral. Iris stromal cysts are classified either as congenital or acquired. Free-floating cysts are usually dislodged pigment epithelial cysts. Secondary cysts are classified according to the underlying cause as implantation cysts, drug-induced, uveitic, tumor-induced, parasitic, or as cysts associated with systemic disorders. Differential diagnosis is based on the clinical presentation and imaging. Ultrasound biomicroscopy is the gold standard for the imaging of iris cysts, combining excellent resolution with sufficient tissue penetration. Treatment of iris cysts depends largely on whether they become symptomatic or not. Symptoms include obstruction of the visual axis, corneal decompensation, secondary uveitis, and secondary glaucoma. Treatment options cover a range from simple observation to fine-needle aspiration (with or without intracystic injection of absolute alcohol or antimitotic agents), laser (argon, Nd:YAG), or surgical excision. In the past, the prevailing notion was that of a radical surgical intervention in the form of iridectomy or iridocyclectomy. Given the high rate of recurrence, a stepwise conservative approach is currently favored by most clinicians.

Treatment of peripheral pigment epithelium iris cyst with SLT laser

PURPOSE

To report a case of a peripheral pigment epithelium iris cyst treated with selective laser trabeculoplasty laser.

CASE REPORT

A 15-year-old girl applied to our clinic with the complaint of painless blurred vision in the right eye. Gonioscopy through a widely dilated pupil revealed a clear, oval, pale brown, semitransparent cyst that was located in the inferotemporal aspect of the iris. The cyst was touching the lens, and the lens was pushed superonasally by the cyst. The iris cyst was treated with selective laser trabeculoplasty laser. A small iris notch emerged at the 8-o'clock position of the pupillary margin. Only mild flare and minimal pigment dispersion were documented postoperatively, which resolved in a few days with a topical corticosteroid.

CONCLUSIONS

Selective laser trabeculoplasty laser may be considered as a potentially useful and relatively less invasive technique in the treatment of peripheral pigment epithelium iris cysts.

Bilateral multiple primary iridociliary cysts - A rare case report

Iridociliary cysts are often found in patients as an incidental finding during a routine ophthalmic evaluation and if asymptomatic do not require any treatment per se. However, these are often mistaken as iris melanoma and the patient is managed accordingly causing a great deal of inconvenience to the patient as well as the doctor.

CASE PRESENTATION

A 69 year old male presented to the ophthalmic out-patients department for routine ophthalmic evaluation. On examination, he is best corrected visual acuity was 6/9, N6 in both eyes. Post-mydriasis evaluation showed a Grade II nuclear cataract in both eyes. There was a smooth, pigmented mass with a rounded surface projecting from behind the iris resembling an iris melanoma. On further evaluation, he was found to have multiple ciliary body cysts.

CONCLUSION

Ultrasound biomicroscopy is a valuable technique in diagnosing iridociliary cysts.