Epithelial iris cyst treatment with intracystic ethanol irrigation

Abstract

Purpose To report the therapeutic effects of ethanol (ETOH) irrigation into epithelial iris cysts (EIC). Study design Retrospective noncomparative interventional case series. Participants 102 eyes of 102 patients aged between 4 and 71 years with EIC, with 4 months to 15 years follow-up. Intervention Under local or general anesthesia, cyst fluid was drained gently via a 27-gauge needle. Without changing the position of the needle, the syringe was replaced with one containing an equal amount of ETOH to the drained cyst fluid, and ETOH was gently irrigated into the cyst. The ETOH was left inside until the cyst wall turned white (about one minute). The ETOH was aspirated and the needle removed. After the irrigation, patients were treated with atropine 1% and dexamethasone 5 ml eye drops. Results Pretreatment findings suggest that the bases of all the cysts were connected either to incisions made during previous operations or to sites of laceration from penetrating trauma. Three types of cysts were identified: single in 88 patients, double in 11 patients, and triple in 3 patients. The cyst wall contained keratic precipitates in three cases, and was vascularized in two cases. Of the 102 cases, 3 were excluded from the study because the EIC was connected to the anterior chamber. Follow-up indicated that 93 cysts resolved after the first irrigation, 3 after the second irrigation and 2 after the third irrigation and 1 case did not respond after third irrigation. The cysts clinically shrank in 78 cases by 1 day after ETOH irrigation and in 20 cases by 2 weeks after ETOH irrigation. Anterior chamber reaction was observed the day after ETOH irrigation in two cases, probably as a result of ETOH leakage, and in nine cases without apparent ETOH leakage. All were treated with dexamethasone 10 ml eye drop for 2 weeks. Intraocular pressure (IOP) normalized in 11 out of 21 cases who had IOP>20 mmHg before ETOH irrigation. Conclusion Ethanol irrigation is a cost-effective and safe procedure, and we recommend consideration of the procedure for treatment of iris epithelial cysts.