Epithelial Iris Cyst Research Articles

Long-term outcomes of \u201copen iridectomy\u201d for secondary anterior chamber epithelial iris cysts

Epithelial cysts run a high risk of recurrence and conversion to sheet-like ingrowth after surgical intervention. In this retrospective study, we introduced a modified iridectomy for treatment of secondary epithelial iris cysts (EICs) in the anterior chamber. Twenty-nine patients (29 eyes) aged 2–61 years received “open iridectomy” for EICs between April 1995 and July 2019. After viscodissection, most of the cyst wall was cut using a 20-gauge aspiration cutter via a 2.5-mm clear corneal incision. The residue closely adhering to the iris stroma was remained to avoid photophobia and diplopia. At 3 months, best corrected visual acuity was ≥ 20/100 in 55.5% (15/27, except two pediatric patients with poor cooperation) of patients. Among the eight patients suffering partial corneal edema preoperatively, six patients received surgery treatment at 3–6.5 months, and the cornea in the other two patients became transparent after medication. In a mean follow-up of 47.4 months, recurrence occurred in 3 patients at 7, 37, and 118 months, respectively. The percentage of treatment success was 96%, 87%, and 65% at 1, 5, and 10 years, respectively. “Open iridectomy” was effective for EICs, with a minimal invasion, less damage to the corneal endothelium, and a low recurrence rate.

Diagnosis and management of post - traumatic pearl iris cyst

Epithelial iris cysts still comprise a mystery with regard to pathogenesis, modes of presentation, and response to treatment. Here, we report an 8-year-old boy who presented with a pearly white iris cyst, 2-year postcorneal tear repair. After Anterior segment optical coherence tomography confirmation, an en block resection of the cyst was done. Eleven months later the patient presented with recurrence of the iris cyst. This recurrence was due to incomplete removal of the epithelial tissue lining the pearly cyst. Ultrasound bio-microscopy (UBM) was done to delineated the posterior extent of the cyst, and a sector iridectomy with a 4 mm margin around the cyst was done. Our case reinforces the fact that delineating the extent of these iris cysts posteriorly with UBM is mandatory in all cases, and it provides a basis for surgical resection for favorable visual outcomes.

Bilateral multiple iridociliary cysts causing secondary pigment dispersion.

Primary epithelial iris cysts are benign innocuous lesions, which are mostly bilateral and asymptomatic in nature. They can lead to creeping angle closure, when the angle progressively narrows due to age-associated changes. This photoessay, herewith, signifies the dual importance of identifying minute bumpy elevations in the iris by a thorough slit lamp examination as well as the use of ultrasound biomicroscopy in patients presenting with creeping angle closure, frequently misdiagnosed in the primary angle closure disease spectrum.

Laser puncture of symptomatic primary iris pigment epithelial cyst causing hemeralopia: a rare case

Primary iris pigment epithelium cysts involve posterior surface of the iris and can occur at pupillary margin or anterior ciliary body. They may be stationary or progressive and sometimes regress spontaneously. These cyst can occasionally lead to angle-closure glaucoma, plateau iris syndrome and secondary pigment dispersion syndrome. A steadily growing cyst may disturb the vision by covering the visual axis and provoke an increase in intraocular pressure (IOP) or even inflammation if it touches the corneal endothelium. There are multiple management options in complicated situations. We report a case of a 17-year-old girl with unusual complaints of hemeralopia and dark-brown discolouration of pupils in both eyes. On examination, she had multiple pigment epithelial iris cysts at the pupillary margins, which were punctured with Nd:Yag laser, and the response was improvement in vision and hemeralopia without any pigment dispersion or IOP changes.

Tectonic Keratoplasty to Restore the Bulbar Wall after Block Excision of Benign and Malignant Intraocular Tumors.

Purpose To report the surgical treatment and follow-up of tumors of the anterior uvea and epithelial cysts of the anterior chamber in 4 patients submitted to block excision and tectonic corneal graft between 2008 and 2012. Methods This is a retrospective, nonrandomized case series. Two patients were affected by anterior uveal malignant melanoma, and 2 patients were referred to us for large epithelial iris cysts with anterior chamber angle involvement and partial corneal failure. A simultaneous block removal of the lesion and adjacent iris, cornea (when necessary), ciliary body, and sclera was performed; the resulting defect was covered by a tectonic whole thickness corneal graft. Follow-up ranged from 2 to 7 years (mean time: 5 ± 1.6 MD). Results Local control of malignant melanoma was observed during the follow-up, but cataract surgery was planned in both patients and pars plana vitrectomy for vitreous hemorrhage occurred in one case. No recurrence of cysts was detected. After iris cysts excision, a planned second-time surgery was necessary in one patient: optical penetrating keratoplasty, centered on the visual axis, implantation of one refractive IOL (intraocular lens) in the bag, and one cosmetic IOL in the sulcus, to restore the iris diaphragm. Conclusions Block excision followed by the tectonic corneal graft seems to be the treatment of choice for selected cases of epithelial cysts of the anterior chamber and anterior uvea melanomas with epibulbar extension. Further surgery, as a second step, could be required to improve functional results of this challenging technique.

A rare occurrence of epithelial inclusion iris cyst after phacoemulsification

A rare occurrence of epithelial inclusion iris cyst after phacoemulsification

Epithelial iris cyst treatment with ethanol irrigation

Epithelial iris cyst treatment with ethanol irrigation

Primary Pupillary Margin Cyst of the Iris Pigment Epithelium

Purpose: Description of a patient with a solitary cyst of the pupillary margin iris pigment epithelium (IPE). Methods: A 63-year-old man referred a suspected iris-ciliary body melanoma in his left eye. Based on both clinical examination and ultrasound biomicroscopy, melanoma was considered unlikely. Surgery was under-taken to correct recurrent deterioration of vision due to movement of the lesion across the visual axis. Results: The lesion was excised completely. Ultrasound biomicroscopy and histopathological examination ruled out melanoma and allowed a final diagnosis of primary pupillary margin cyst of the IPE, characterized of pig-mented epithelium, with no connective tissue or vessels. No recurrences or fresh lesions appeared during a one-year follow-up. Conclusions: Primary epithelial iris cysts are usually benign. Treatment is required only in symptomatic patients and those with an uncertain diagnosis. Ultrasound biomicroscopy is indispensable to confirm the clinical diagnosis, follow the clinical course and intervene if surgery is required.

Surgical treatment and histopathology of a symptomatic free-floating primary pigment epithelial iris cyst in the anterior vitreous

We report the surgical removal of an iris pigment epithelial cyst that was floating freely in the posterior chamber of an 18-month-old child. The reason for surgical removal was disturbance in near vision secondary to the movement of the cyst across the visual axis. Visual disturbance secondary to a unilateral anterior vitreous iris cyst at this age is a rare presentation and, to the best of our knowledge, has not been reported previously as an indication for surgery. We performed histopathological study of the cyst aspirate to determine its contents and its possible origin.

Ipsilateral ciliary body schwannoma and ciliary body melanoma in a child

An 11-year-old boy presented with a mid-zonal pigment epithelial iris cyst. The cyst progressed relentlessly, ultimately leading to enucleation of the eye 4 years after presentation. Histopathology revealed a ciliary body schwannoma filling the anterior chamber and a small, incidental noncontiguous ciliary body melanoma. Vision loss, pupil distortion, and relentless growth despite complete cyst deflation following aspiration were clues for the tumor-induced nature of the visible cyst.

Precipitate inside the epithelial iris cyst: a report of two cases

Epithelial iris cyst is a rare disease with various complications. To our knowledge, precipitate formation inside the cyst has never previously been described. The purpose of this report is to introduce this extremely atypical complication of epithelial iris cyst. This case report presents two men out of 142 cases, aged 30 and 36, with epithelial iris cyst who developed precipitate level inside the lesions. The cyst fluid was drained and sent to the laboratory. Intracystic ethanol irrigation was performed as a treatment procedure. The patients were followed for 2 and 8 years. There was no inflammatory response outside the cysts. Both cysts contained lymphocytes and one included epithelial cells, but neither contained organisms. The cysts were treated successfully by intracystic ethanol irrigation. Intracystic precipitate formation is a rare manifestation of the epithelial iris cyst.

Implantation epithelial iris cyst following the perforating corneal injury

The objective of this case report was to present the development of implantation cyst following the perforating corneal injury, the problems related to the treatment, including total surgical excision of the cyst, the secondary cataract extraction, iridoplasty and the artificial intraocular lens reposition. A patient first presented with perforating corneal injury inflicted by a piece of wood, with the iris prolapse. Primary wound management, reposition of prolapsed iris and corneal sutures were performed four days after the injury. Eight months later, the patient was rehospitalized due to an implantation iris cyst and traumatic cataract. The cyst was excised, the extracapsular cataract extraction was done and the anterior chamber lens was implanted. Postoperative visual acuity was normal. Three years later, the patient presented for a follow-up examination, with the cyst filled up again, occupying two thirds of the anterior chamber. This time, the cyst was completely excised, all fibrous remnants of the secondary cataract were removed, and the iridoplasty was necessary due to large iris coloboma. Reposition of the anterior chamber lens was carried out. Histological examination revealed an implantation iris cyst covered by multilayered squamous epithelium. Normal visual acuity was achieved. The patient has been followed-up for six months uneventfully. Management of perforating corneal wound with iris prolapse may lead to development of an implantation iris cyst. Puncture of the cyst as well as incomplete excision will not solve the problem. Complete surgical removal of the iris cyst is the treatment of choice.

Laser Photocoagulation of Primary Central Pigment Epithelial Iris Cysts

A 13-YEAR-OLD GIRL had been bothered for several years by increasing episodes of transitory “blindness” in her right eye. These usually occurred outdoors under bright, sunny conditions. One year earlier, she had been diagnosed as having iris cysts. Therapy with the mydriatics 1% tropicamide and 2.5% phenylephrine hydrochloride achieved no perceptible effect. She had no other history of use of ocular medications. On examination, her bestcorrected visual acuity was 20/25 OD and 20/20 OS. With bright light, the vision in her right eye decreased to less than 20/400. Slitlamp examination showed multiple, dark-brown iris pigment epithelial cysts along the pupillary margin of the right eye, with the visual axis open when the pupil was not fully constricted (Figure 1). Obstruction of the visual axis by the cysts was easily demonstrated by using brighter illumination (Figure 2). Argon laser photocoagulation of the 2 larger cysts was performed with topical anesthesia. A drop of 0.15% brimonidine tartrate was instilled before and after treatment. Fifty burns, each of 500-mW power, 200millisecond duration, and 50micrometer spot size, were used to rupture and then shrink the cysts’ walls (Figure3). No postlaser complications occurred, including elevation of intraocular pressure or excessive inflammation. At 9 months’ follow-up, the patient reported no further episodes of visual disturbance.

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

We report the case of a 2-day-old child with buphthalmia caused by a congenital pigmented epithelial iris cyst. The use of ultrasound biomicroscopy (UBM) and high-resolution echography (20MHz) specified the diagnosis before general anesthesia for complete examination and treatment. Surgery can control intraocular pressure and the opening of the visual axis; there is, however, relative amblyopia. This case confirms the advantage of UBM in examining tumors of the anterior segment. The early diagnosis, facilitated by use of the UBM, provided quick and well-adapted treatment.

Epithelial iris cyst treatment with intracystic ethanol irrigation

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.

This Issue of Acta

Several contributions in this issue deal with treatment of age-related macular degeneration with transpupillary thermotherapy (TTT). Macular degeneration has defied intensive therapeutic efforts for a long time, and it may be motivated to consider TTT as great a promise for patients with macular degeneration as photodynamic therapy (PDT). TTT can also be administered at a fraction of the cost as compared to PDT. The results reported by Algvere and coworkers in a safety and efficacy study are commented on in the Guest Editorial by Ciulla, who concludes that the results of the large prospective material in Algvere's paper ‘corroborate and amplifies the previous studies that suggest a role for TTT in the treatment of occult CNVM, lesions with minimal or no benefit from PDT’. These results are very important, and we must agree with Ciulla that we are now at the stage when we must look forward to the results of a randomised, prospective TTT trial. Everything has a downside, however. Salinas-Alamán and coworkers describe a case of over-treatment with TTT in a letter to the editor. The review article in the current issue is on a highly modern subject: telemedicine in ophthalmology, authored by Lamminen and coworkers. Telemedicine holds great promise making specialty care available everywhere. Studies have shown that the concept works, but cost efficiency has not been conclusively proven. The potential value of telemedicine is particularly large in the Nordic countries, where distances are often great. The technological solutions are available, and we are waiting for a situation when also the organisational aspects have been addressed and solved. The Clinical Questions and Answers section discusses the management of a patient with an inadvertent filtration bleb after phacoemulsification with suture-less wound closure. The patients had disturbing symptoms, and treatment was not without problems. Primary papillary pigment epithelial iris cysts are rare. In the Diagnosis and Therapy in Ophthalmology section Sallo and coworkers show beautiful pictures pre and post surgery in two patients with this condition. Original articles in this issue cover a broad spectrum of ophthalmology. In an unusual, prospective study Tranos and coworkers have compared the subjective visual experience of patients during phacoemulsification and IOL implanation with regional versus topical anesthesia. A study by Splunder and coworkers involving 900 Dutch adults with profound intellectual disabilities found that many had nonoptimal spectacle correction and that more than half of those needing reading glasses did not have them. The results are similar to those reported by Warburg in this journal (Warburg 2001), and suggest that visual function screening is motivated in persons with intellectual disabilities. Fahnehjelm and colleagues describe four cholestatic infants with optic nerve hypoplasia; three of them were blind or had low vision. Early assessment by paediatric ophthalmologists is important in children with neonatal cholestasis. Uretmen and coworkers have studied psychosocial implications of strabismus– reactions of school teachers to digitally altered photographs of children with and without strabismus, and showed that the children were rated more negatively when strabismic. Fledelius and coworkers report findings of orbital ultrasound sonography in a large series of patients with thyroid-associated orbitopathy. Most patients had increased muscle thickness, and the examination techniques could not discern between inflammatory and fibrotic changes. Two studies deal with glaucoma. Naruse et al. describes a new technique to remove the inner wall of Schlemm's canal during nonpenetrating surgery using cyanoacrylate. Inan and coworkers found increased blood flow velocities in retro-bulbar vessels both in eyes treated with latanoprost and with brimonidine. Akyol et al. found that levels of serum trace elements were considerably lower in chronic heavy smokers than in controls, and were associated with reductions in contrast sensitivity functions. Trace element alterations may play a causative role in the smoking induced retinal toxicity. Conjunctival papillomas may be very difficult to treat. Keizer and de Wolff-Rouendaal describe two cases with conjunctival papillomas that were successfully treated with alpha-2-interferon eye drops, after previous unsuccessful management with a variety of treatment modalities. There are many basic science papers in this issue. Söderberg et al. have developed a new method to estimate a threshold UV radiation dose for cataract. Wiencke and coworkers found that not only ‘good looks’ (histologically!), but also DNA profiles should be taken into account when retinal pigment epithelium is cultured for transplantation purposes. Two articles have studied Vitamin E. Bilgihan et al. investigated the effects of this vitamin administered topically in conjunction with photorefractive keratectomy. Yargicoglu found that vitamin E had a protective effect against stress-induced VEP changes in a rat model. And do not forget to read some interesting letters in this issue!

Recurring transitory blindness caused by primary marginal pigment epithelial iris cysts

PURPOSE: To report four cases of primary pupillary pigment epithelial iris cysts, all members of one family, in which two of the patients had recurring transitory visual impairment. METHODS: Observational case series. History was taken, the patients were examined with slit-lamp and ultrasound biomicroscopy, and surgically removed cyst tissue was examined with transmission electron microscopy. RESULTS: Pupillary pigment epithelial cysts of the iris generally show an autosomal dominant heredity pattern, with occasional lack of penetrance. In two of our cases, the size and location of the cysts caused visual symptoms, necessitating surgical removal. The cyst wall consists entirely of pigment epithelial cells. CONCLUSION: The origin of pupillary pigment epithelial cysts is unclear, and a hereditary background is very likely. Their clinical significance is in their similarity to pigmented tumors of the iris. They may also be indicative of coexisting systemic disease. In symptomatic cases, treatment is indicated.

Congenital Nonpigmented Epithelial Iris Cyst after Amniocentesis: Clinicopathologic Report on Two Children

Congenital nonpigmented epithelial iris cysts are not common. They may arise spontaneously from developmental entrapment of surface ectodermal epithelium or from occult ocular trauma prenatally or at birth. Between 1989 and 1991, an 8-month-old child and a 6-year-old child presented with large, progressive congenital epithelial iris cysts. Both children had a maternal history of diagnostic amniocentesis after an ultrasound scan, and there was no history of postnatal ocular trauma. The cysts were successfully removed by a modified block excision and tectonic corneoscleral grafting. A dense adherence of the cyst wall to Descemet's membrane resembled old anterior synechiae after occult perforation of the globe in both patients. On histopathologic examination, the epithelial lining of the cysts consisted of non-keratinizing stratified squamous epithelium with goblet cells resembling conjunctival epithelium. A perforating limbal scar with a corresponding break in Descemet's membrane could be detected in one eye. The long-term visual acuity of both children was encouraging, and there was no evidence of recurrence of the iris cyst during the follow-up period (average, 23 months). The authors conclude that the clinical and histopathologic features of these congenital iris cysts may be consistent with an occult intrauterine limbal perforation of the anterior chamber with a needle during amniocentesis. Amniocentesis, when not guided by a real-time ultrasound scan, may be a risk factor for prenatal ocular trauma, which should be considered in the differential diagnosis of congenital ocular disorders.

Congenital nonpigmented epithelial iris cyst removed by block-excision

A 1-month-old white girl developed a rapidly progressing congenital nonpigmented iris cyst covering the pupil and displacing the lens and ciliary body. The cyst was completely removed using a modified block excision (9 x 3.5 mm). The tumor consisted of partially keratinizing cuboidal epithelium with goblet cells, which was covered by proliferating corneal endothelium on the outside. Histopathological, and scanning and transmission electron microscopic findings are described. The postoperative course is unremarkable for 1 year. To our knowledge this case is the first case of a congenital iris cyst successfully treated with block-excision.

Epithelial iris cyst after cataract surgery

We report a case of an epithelial inclusion cyst of the iris following cataract surgery that was successfully treated with en bloc excision, after an unsuccessful attempt with Neodymium-doped Yttrium Aluminium Garnet (Nd YAG) Laser. A 60-year-old man had undergone cataract surgery two years back. One year later, he developed a pigmented epithelial inclusion cyst of the iris which progressively increased in size. His vision reduced to finger counting close to face as the cyst grew over the pupil. We performed Nd YAG laser cystotomy of the cyst wall initially, but the treated lesion recurred. So we performed an en bloc iris excision of the cyst with sector iridectomy. There was no recurrence as determined by slit lamp examination at six months after treatment. Hence, we conclude that en bloc excision can be used to effectively treat epithelial inclusion cyst of the iris.