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Session Title: Complex Cases and Surgery
Session Date/Time: Monday 07/10/2013 | 14:30-16:00
Paper Time: 15:39
Venue: Forum (Ground Floor)
First Author: : H.Sitnik BELARUS
Co Author(s): : Z. Avtushko V. Vitt
To describe a case of giant cyst in the left eye anterior chamber of a 84-year old woman.
Belarusian Medical Academy of Postgraduate Education, 10-th clinical hospital, Minsk, Belarus
Patient was referred to our clinic for visual acuity reduction to hand movement in her right eye. Examination included visual acuity testing, slit-lamp biomicroscopy, tonometry, gonioscopy, ophthalmoscopy. The left eye"s visual acuity was 20/40. Woman underwent uneventful phacoemulsification and rigid IOL implantation via 5.5 mm clear corneal incision in her left eye eight month ago. Biomicroscopy revealed advanced lens opacities and pseudoexfoliates on lens capsule and iris in the right eye. The left eye showed corneal post-op scar and 10-0 suture covered with epithelium on 12 clock. A small conjunctival cyst 2x2 mm connected with the scar was detected. A giant cystic mass was visualized in the anterior chamber of her left eye. The cyst walls and content were transparent. Pupil margin was deformated and partially everted, iris pigment was dispersed in the anterior chamber. IOL was visualized behind the cyst. The IOP level was 20 mm Hg on the right eye and 16 mm Hg on the left eye.
Upon anterior segment examination of the left eye, we had to differentiate between vitreous prolapse, secondary iris cyst and tumor. UBM showed anterior chamber cyst sized 7,23?4,41??, the content of cyst was homogeneous. The adhesion of cyst wall and corneal scar was revealed. The IOL located in the bag was slightly shifted backward. Cylliary body was intact, no signs of tumor or vitreous prolaps were detected. OCT allowed to define more precisely the cyst structure. The cornea thinning in area of corneal scar and iridocorneal adherence were revealed. OCT-scans clearly showed close adherence of the iris and cyst. Moreover, transformation of the iris in the cyst wall was visualized. Opthalmoncologist found no signs of tumor. Finally, the diagnosis of secondary iris cyst of the left eye was made. Whereas patient had no complaints, IOP was normal, visual acuity of the left eye was 20/40, the decision was not to remove the cyst but to do phacoemulsification on the right eye. The visual acuity of the right eye was 20/60 1 month post-operation. 1-year observation showed no changes in visual acuity, IOP, cyst dimensions and size. AMD was diagnosed on the right eye. Final visual acuity was 20/40 on both eyes.
Secondary iris cyst is one of the late complications of the cataract surgery. The cause of anterior chamber cyst in our patient is epithelial ingrowth after phacoemulsification. The anterior OCT allows to differentiate the specific signs of this rare pathology. The management strategy depends on many factors including visual acuity, IOP, corneal opacity etc. Giant epithelial cysts can be managed conservatively in selected patients with good results.
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