Cyst In Anterior Chamber Research Articles

Pediatric Free-floating Anterior Chamber Cyst of the Iris Pigment Epithelium

Iris pigment epithelial (IPE) cysts are a subset of iris cysts that arise from the IPE. They are spontaneously erupting epithelial-lined cavities that are found in various anatomic locations of the iris, including the iris pupillary margin, midzone, periphery, and free floating in the vitreous or anterior chamber. We report the case of an asymptomatic 13-year-old boy with an incidental finding of a dislodged anterior chamber cyst diagnosed on routine examination. Modern multimodal image analysis of the cyst including anterior segment optical coherence tomography and ultrasound biomicroscopy (UBM) was utilized to characterize the microstructural anatomy of the lesion. The patient was managed conservatively without complications. Cysts of the IPE typically do not affect vision or ocular health and can be monitored and observed after ascertaining no associated malignancy. Initial diagnostic investigation can include UBM and anterior segment optical coherence tomography. Intervention should be reserved only for cases where the cyst growth leads to obstruction of the visual axis and/or other secondary complications.

Iris cyst in a child with Aicardi syndrome: a novel association

Aicardi syndrome is a rare X-linked cerebro-retinal disorder characterized by agenesis or dysgenesis of the corpus callosum, seizures, and chorioretinal lacunae; microphthalmia or optic nerve coloboma may also be observed. We report the case of an infant born with severe ocular malformations, including an anterior chamber cyst in one eye, which was surgically removed.

Golden retriever cystic uveal disease: a longitudinal study of iridociliary cysts, pigmentary uveitis, and pigmentary/cystic glaucoma over a decade in western Canada.

To determine the incidence of iridociliary cysts, pigmentary uveitis (PU)/pigmentary cystic glaucoma (PCG) in golden retriever dogs in western Canada, the progression of iridociliary cysts to PU/PCG, and a mode of inheritance for this disorder. A total of 830 golden retriever dogs from Alberta, Saskatchewan, and Manitoba from 2004 to 2014 were studied. Data were compiled from Canine Eye Registry Foundation (CERF) or Orthopedic Foundation for Animals (OFA) records (n=630) and clinical consultations (n=200) for a retrospective assessment of iridociliary cysts, PU, and PCG. Total incidence of iridociliary cysts and PU from CERF/OFA data were 4.8% (n=30/630) and 5.9% (n=37/630), respectively. Incidence of PU increased with ages >4years (12.7%, n=32/251). Dogs diagnosed with thin-walled, attached iridociliary cysts had a high risk of being diagnosed with PU or PCG upon re-examination (56.5%, n=13/23). No dogs diagnosed with thick-walled, anterior chamber cysts (n=7) developed PU or PCG within the time frame of the study. Data from clinical consultations confirmed that PU carried a poor prognosis for the affected eyes as 44.9% (n=22/49) of dogs progressed to PCG. PU- and PCG-affected dogs followed a familial pattern and there was an association with thin-walled iridociliary cysts. Pedigree analysis suggested an autosomal dominant mode of inheritance with partial penetrance. Thin-walled iridociliary cysts are associated with PU and PCG. All breeding golden retriever dogs should be examined annually by an ophthalmologist. The incidence of this disorder is higher in western Canada than previous reports in North America.

Corneoscleral Block Excision Grafts: Indications, Techniques, and Outcomes

The purpose of this article is to discuss the indications, techniques, and outcomes for corneoscleral grafts in sight-threatening ocular disease. We conducted a single-center review of 12 medical records of patients who underwent corneoscleral grafts by a single surgeon (R.K.F.) from 1983 through 2004. The 4 primary indications for undergoing a corneoscleral graft included infection, anterior chamber cyst, epithelial downgrowth, and invasive squamous cell carcinoma. The surgical technique involved en bloc excision of the lesion followed by placement of cadaveric corneoscleral tissue to reapproximate the original structures in the region. The surgical technique was modified to suit the individual indication and degree of involvement. Visual acuity, recurrence, complications, and time to rehabilitation are discussed. Histopathologic evaluation for each case was performed. Best-corrected visual acuity improved in 3 of 12 eyes. Vision of 20/50 or better was maintained in 5 of 12 eyes, and a visual acuity between 20/60 and 20/300 was achieved in 5 of 12 eyes. One patient with epithelial downgrowth had progression to phthisis bulbi, and 1 patient with squamous cell carcinoma experienced recurrence of the primary disease process resulting in enucleation. Patients undergoing placement of large corneoscleral grafts have a guarded prognosis; however, this extensive, technically difficult, surgical intervention may allow patients to preserve and/or improve their visual function.

Viscoexpression of large free floating cysticercus cyst from the anterior chamber of the eye by double incision technique

We describe a case of 16-year-old girl who reported with diminution of vision in left eye for past seven months with appearance of white reflex. Slit lamp biomicroscopy revealed the presence of a live grayish white cyst in the anterior chamber. The ultrabiomicroscopic evaluation revealed a large live Cysticercus cellulosae cyst in anterior chamber. The CT-scan of the brain revealed multiple non-contrast enhanced lesions with calcification in brain parenchyma. The patient was started on oral prednisolone and oral albendazole. The cyst was removed in toto from the eye by double incision technique. The patient achieved visual acuity of 6/12 post-operatively.

Tratamiento quirúrgico conservador en un caso de quiste de iris postraumático

A 32-year-old man with recent visual loss in his right eye, was found to have an iris cyst involving about 50% of the anterior chamber. He had been treated three years previously for a penetrating injury to that eye. The cyst was treated by aspiration, viscodissection and ab-externo photocoagulation, with this achieving a rapid recovery of vision and good anatomic results. At the six month follow-up visit the visual acuity remains stable with no signs of recurrence of the cyst. Conservative surgical treatment consisting of aspiration, viscodissection and photocoagulation appears to be an effective strategy to manage secondary anterior chamber cysts, achieving good anatomic and functional results.

Differential diagnosis of anterior chamber cysts with ultrasound biomicroscopy: ciliary body medulloepithelioma

To describe a case with motile cyst in the anterior chamber in the right eye of a 7-year-old boy. The right eye's visual acuity was 20/50. Intraocular pressure was 59 mmHg. Slit-lamp examination showed prominent rubeosis iridis and a grey-white mass floating freely in the anterior chamber. Ultrasound biomicroscopy revealed a cystic mass in the anterior chamber. A diagnostic cyclectomy with removal of the anterior chamber cyst was performed. Histopathology of the anterior chamber lesion showed an intact cyst composed of medullary epithelial cells. Medulloepithelioma with malignant criteria was diagnosed and the eye was enucleated. Pathology demonstrated an medulloepithelioma with a few mitotic figures and nuclear pleomorphisms within the ciliary body. The patient was followed for 8 months without any metastasis in the orbit or elsewhere. Intraocular medulloepithelioma is a rare embryonic benign or malignant neoplasm typically diagnosed in the first decade of life as a ciliary body mass. A dislodged, free-floating anterior chamber cyst associated with neovascular glaucoma is typical of medulloepithelioma in children. This unique presentation should be differentiated from congenital iris epithelial, post-traumatic, epithelial, parasitic and neoplastic cysts. Ultrasound biomicroscopy is useful for analysing the structure of the anterior segment mass. Ciliary body medulloepithelioma is characterized by echogenic mass heterogeneity and an irregular surface containing multiple cystic cavities. Lack of glial differentiation may predict a better clinical outcome in primary neuroectodermal brain tumours.

Corneal neural paralysis after block excision including the 3 and 9 o'clock meridian

Corneal innervation is mainly supported by the long posterior ciliary nerves. Anatomically, the long ciliary nerves run with the long ciliary arteries at 3 and 9 o'clock. The aim of this retrospective study was to find out if block excision of anterior uveal tumors or epithelial ingrowth located at the 3 or 9 o'clock position of the limbal circumference causes corneal neuroparalysis. Between 1980 and May 1999, a total of 151 block excisions were performed in our department (92 block excisions because of anterior uveal tumors and 59 because of cystic epithelial ingrowth to the anterior chamber). In 27 patients, anterior uveal tumors or cystic epithelial ingrowth were located at the 3 or 9 o'clock position of the limbal circumference (14 patients with cystic epithelial ingrowth and 13 patients with anterior uveal tumors). Mean age of all patients was 54.4 +/- 15.7 years at the time of surgery. Mean diameter of the block excision was 10.7 +/- 4.5 mm for tumor-patients and 9.0 +/- 1.2 mm for patients with anterior chamber cysts. Mean follow-up time was 93.6 +/- 43 months. Only 1 of 27 patients exhibited a moderate neuroparalytic corneal ulcer during the follow-up time. In the remaining 26 patients, no signs of clinically relevant corneal neuroparalysis such as epithelial disorders or neuroparalytic ulcers were found. Block excision of tumors or cystic epithelial ingrowth located at the 3 or 9 o'clock position of the limbal circumference did not lead to severe neuroparalytic disorders of the host cornea. This may be an important factor in postoperative management of patients undergoing block excision and corneoscleral grafting.

Corneoscleral block excision of postoperative anterior chamber cysts

To describe the clinical presentation, surgical treatment and histopathology of three cases of cystic epithelial ingrowth occurring after cataract surgery.Three patients developed anterior chamber cysts, two with an associated conjunctival bleb and fistula, following extracapsular cataract and phacoemulsification surgery. The technique of block excision and corneoscleral graft was used in the three patients.There was no evidence of recurrence twenty-six, twenty-three and seven months postoperatively. Visual acuities were 20/30, 20/20-2 and 20/25-2, with mild astigmatism and well controlled intraocular pressure. Histopathology illustrated that conjunctival and corneal epithelium invaded the anterior chamber through a wound defect.At this time, block excision with a corneoscleral graft may be the most definitive surgical treatment of cystic epithelial ingrowth.