Iris Cyst: Case Management And Clinical Results

This report aims to present a case of a 64-year-old patient with corneal decompensation caused by bullous keratopathy and a recurring retroiridic cyst. The patient’s clinical journey is highlighted through various surgical interventions, including Descemet Membrane Endothelial Keratoplasty (DMEK) and multiple cyst drainage procedures, and emphasizes the potential of prosthetic iris devices in managing such challenging cases. This report will discuss the management strategy, the surgical outcomes, and the clinical results achieved, with particular focus on the effectiveness of prosthetic iris implantation in preventing cyst recurrence and maintaining visual acuity.

Fundación de Oftalmología Médica de la Comunitat Valenciana, Valencia, Spain.

Cornea and Anterior Segment Disease Unit.

A 64-year-old male was referred for corneal decompensation due to bullous keratopathy and a retroiridic cyst in the inferior left eye, near a previous nasal inferior iridectomy. The patient underwent a DMEK, which was successful with improved visual acuity from counting fingers at ½ meter to 0.12 LogMAR. Nine months later, the cyst regrew, causing edema and anterior synechiae, which led to reduced endothelial cell count. Cyst drainage and excision of synechiae were performed, and histopathology revealed minimal stromal cellularity without atypia. A postoperative intraocular pressure spike was controlled with antihypertensive therapy. Visual acuity improved to 0 LogMAR with correction. However, the cyst recurred after six months, leading to a second drainage procedure. The cornea stabilized with glucocorticoid treatment, and visual acuity remained at 0.05 LogMAR at the 12-month follow-up. Two years later, the patient developed a central corneal infection caused by Morganella morganii, which was treated successfully with amikacin. A third aspiration was performed, but full cyst resection was achieved through penetrating keratoplasty (PK). A prosthetic iris segment was used to replace the resected iris tissue, and the patient showed stable visual acuity with no cyst recurrence.

This case demonstrates the challenges of managing retroiridic cysts and epithelial downgrowth after ocular surgery. Despite multiple interventions, including cyst drainage, alcohol lavage, and PK, the cyst persisted. The use of a prosthetic iris segment was an innovative solution that helped prevent further cyst growth and maintain visual stability. Although risks like posterior extension exist, this approach offers a valuable tool in treating such complex cases. The patient’s favorable outcome underscores the potential of prosthetic iris devices in managing corneal decompensation and cyst recurrence, with promising results for similar future cases.