Cataract formation with a primary iris stromal cyst

Primary stromal iris cysts treated successfully with ab externo laser Nd:YAG photocoagulation

Two boys presented with primary solitary stromal iris cyst in the inferior quadrant. Both patients were treated with Nd:YAG laser puncturing the cyst wall. The cyst wall collapsed and fluid leaked out in the anterior chamber. No complication was noted. The cyst recurred in the first child at 2 months of follow-up and was re-treated with laser. There was no further recurrence after 12 months of follow-up in case 1 or after 10 months of follow-up in case 2. To the authors' knowledge, this is the first documented report of Nd:YAG treatment of primary stromal cyst.

Primary iris stromal cyst with rapid growth

PURPOSE

To describe the clinical features and the surgical management of primary iris stromal cyst with rapid growth.

METHODS

A 14-year-old Chinese-Mongolian girl was referred to us with a 1-month history of obstructed vision and photophobia. On an examination, a semitransparent cyst with a densely pigmented posterior wall was revealed in the anterior chamber of the left eye. The information regarding the location and extent of the cyst was further analyzed by anterior segment optical coherence tomography and ultrasound biomicroscopy. It arose within the iris stroma, measuring 7.52 x 3.60 mm. Blood vessels on the surface of the lesion were revealed by iris angiography. There was no history of amniocentesis, birth trauma, antecedent ocular injury, or maternal illness during gestation. The diagnosis of primary iris stromal cyst was made. A combination of needle aspiration, piecemeal resection of cyst wall, cryotherapy, and argon laser photocoagulation with overlapped spots was used.

RESULTS

Histopathology of the cyst wall revealed nonkeratinized, multilayered, stratified squamous epithelium with clusters of goblet cells. Complete resolution of the cyst was successfully achieved. The visual acuity improved to 20/25 from counting fingers. At 6 months of follow-up, there was no recurrence.

CONCLUSIONS

Complete eradication and devitalization of any remaining epithelial cells are the key factors for preventing recurrence and diffuse epithelialization of the anterior chamber.