ESCRS - PO019 - An Bi-Lobed Iris Cyst

An Bi-Lobed Iris Cyst

Published 2024 - 42nd Congress of the ESCRS

Reference: PO019 | Type: Case Report | DOI: 10.82333/csdh-7m40

Authors: David López Delgado* 1 , Miguel Jonay Acosta Darias 1 , Zaira Hernandez Gonzalez 2 , Sara Judith Galido Hernández 3 , Carla Arteaga Henriquez 1 , Luis Reyes Gallardo 1

1Ophtalmology,CHUC,Santa Cruz de Tenerife,Spain, 2GP,CHUC,Santa Cruz de Tenerife,Spain, 3Endocrinology,CHUC,Santa Cruz de Tenerife,Spain

Purpose

To review the influence of cataract surgery on the appearance of a serous iris cyst. 
To explain the characteristic clinical presentation of a serous iridian cyst, in our case bi-lobulated.
To evaluate the extent, depth and characteristics of this cystic lesion using different diagnostic techniques. 
To present the different therapeutic options for the management of this type of iridocyst lesion. To emphasise that the best treatment for asymptomatic cysts is to watch and wait.

Setting

UNIVERSITY HOSPITAL OF THE CANARY ISLANDS, OPHTALMOLOGY SECCION

Report of case

A 68-year-old patient was referred to the emergency department by his general practitioner with a suspected asymptomatic and spontaneous melanocytic iridocytic lesion. 

Medical history: High blood pressure and diabetes mellitus 2
Ophthalmological history: bilateral cataract surgery 2020. 

CVAM: 

  • Left eye: 20/25.
  • Right eye: 20/25.

 

IOP: 17/16 mmHg.

 

Slit lamp anterior segment:

  • Left eye: Cornea clear, F-, Tyndall-, EFRON I mixed hyperemia, pseudophakic. Looking at the iris, there is an iridial cyst with a serous bi-lobulated appearance at the inferior pole (5-7 hours). The cyst exposes the posterior iris like a Darth Vader mask.
  • Right eye: Cornea clear, F-, Tyndall-, no conjunctival hyperemia, pseudophakic. 

OCT of the anterior segment: 

  • Left eye: Stromal iris cyst extending from the central part of the iris to the periphery. 

 

Treatment: 

In the face of an asymptomatic serous stromal iridial cyst, we have decided to follow up the patient closely every 3 months. We will consider fine needle aspiration, intracystic injection of alcohol or antimitotics, ND-YAG laser or even surgery if at any time there are complications from the cyst such as obstruction of the visual axis, secondary glaucoma, corneal decompensation or recurrent episodes of iridocyclitis.

Conclusion/Take home message

Iridic cysts, probably secondary, as in this case, are the result of implantation, either by surgical trauma. In these cases, we find a thick wall of medium reflectivity with septated transparent fluid, unilateral and usually solitary, surrounding the iridian stroma. The most important thing is to be aware of their tendency to grow, sometimes seasonally, causing diferent complications (visual axis obstruction, secondary glaucoma, pumped iris).

 

If we focus on asymptomatic serous stromal iris cysts, the best therapy is observation. Follow-up is every 3 months. If we focus on symptomatic serous stromal iris cysts, we could start with fine-needle aspiration, intracystic injection of alcohol or antimitotics, ND-YAG laser and even surgery.