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Managing a large iris cyst caused by epithelial downgrowth

Poster Details

First Author: M. Teo UK

Co Author(s):    R. Rampat   R. Angunawela                 

Abstract Details


To describe the management of bullous keratopathy and corneal decompensation secondary to a large iris cyst, following past penetrating globe injury with retained glass foreign body. The iris cyst occupied the temporal one-third of the anterior chamber and was adherent to the endothelium.


Moorfields Eye Hospital, London


Whilst awaiting surgery, corneal decompensation and bullous keratopathy was managed with a bandage contact lens and 5% sodium chloride drops. During surgery, a needle connected to a three-way tap was used. One syringe was used to aspirate the cyst contents through the cornea. The stop-clock was turned to deliver absolute alcohol from a second syringe into the cyst without moving the tip of the needle. Three cycles of aspiration and injection of absolute alcohol was carried out, with each cycle lasting one minute. This was followed by balanced salt solution exchange within the cyst and a separate anterior chamber washout.


By 3 weeks post-op, the cyst had completely collapsed and devitalised. There was minimal inflammatory reaction. Improvement of best corrected vision from 6/36 to 6/18 was observed. Corneal clarity was visibly improved. Intraocular pressure was still slightly raised so dorzolamide eye drops were continued, with dexamethasone and moxifloxacin eye drops. The patient was then listed for a combined Descemet Membrane Endothelial Keratoplasty and Cataract surgery, with the aim of further improvement in vision and comfort.


An attempt to surgically excise a large secondary iris cyst can risk dissemination of epithelial downgrowth cells from the cyst, leading to conversion to the more aggressive sheet form of epithelial ingrowth. This can have catastrophic consequences, including loss of vision, secondary glaucoma and a painful eye. Therefore, such cysts must be managed carefully. Intra-cystic injection of absolute alcohol as a sclerosing agent can be a useful treatment in managing large secondary iris cysts.

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