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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 28  |  Issue : 3  |  Page : 208-209

Congenital vitreous cyst in a child: A rare case report


Department of Pediatric Ophthalmology and Strabismus, Global Hospital Institute of Ophthalmology, Sirohi, Rajasthan, India

Date of Web Publication2-May-2017

Correspondence Address:
Dr. Amit Mohan
Global Hospital Institute of Ophthalmology, Abu Road, Sirohi, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kjo.kjo_21_17

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  Abstract 

Intravitreal cyst is a very rarely reported case in children. Here, we report a case of a 10-year-old male child who presented in outpatient department with a complaint of floater in his right eye which was changing its position with movement of eye but did not increase in size since the past 1 year. Visual acuity was 20/20 in both eyes. On slit-lamp examination, right eye showed a solitary pigmented unilateral freely floating cyst in the vitreous and left eye was normal. The indirect hemagglutination tests of the patient for Echinococcus and cysticercosis were negative. Eosinophilia was not detected in the peripheral blood smear. Based on these findings, the patient was diagnosed as a primary vitreous cyst. The patient had few symptoms, so it was decided to follow the patient without any treatment.

Keywords: Congenital, floater, vitreous cyst


How to cite this article:
Mohan A, Kaur N. Congenital vitreous cyst in a child: A rare case report. Kerala J Ophthalmol 2016;28:208-9

How to cite this URL:
Mohan A, Kaur N. Congenital vitreous cyst in a child: A rare case report. Kerala J Ophthalmol [serial online] 2016 [cited 2019 Sep 20];28:208-9. Available from: http://www.kjophthal.com/text.asp?2016/28/3/208/205422


  Introduction Top


Vitreous cysts are rarely seen, so they are regarded as ocular curiosities. They are usually diagnosed on routine examination of either anterior segment by slit lamp or posterior segment by indirect ophthalmoscope or slit lamp biomicroscopy with 90 D. Vitreous cysts can be congenital or acquired. Congenital cysts are either pigmented or nonpigmented, the former usually arising from pigment epithelium of ciliary body and the later from remnants of primary hyaloid vascular system. They are generally fixed – nonpigmented cysts are typically attached to the optic disc but can be free floating in posterior (occasionally anterior) segment. Acquired cysts are being caused by a number of pathologies such as trauma or inflammation. Treatment is seldom required, but laser cystotomy or vitrectomy can be performed for troublesome cases.[1]


  Case Report Top


A 10-year-old male child presented in our outpatient department with a history of floater in his right eye since the past 1 year. There was no history of trauma and any systemic disorder. Anterior segment of both eyes was normal. Intraocular pressure was 18 and 16 mmHg in his right and left eye, respectively, with Goldmann applanation tonometer. After dilation, right eye showed 6 mm × 4 mm of solitary pigmented freely floating cyst in vitreous [Figure 1]. Indirect ophthalmoscopy and posterior segment biomicroscopy performed with a 90 D lens were unremarkable in the left eye, but a single, oval 6 mm × 4 mm diameter cyst was identified in the right eye, floating freely in the vitreous. The cyst was partially masking the underlying retinal vasculature. B-scan ultrasonography showed an echo-free, round-shaped cyst that was free from surrounding vitreous strands or retina. Optical coherence tomography was normal in both eyes. Serology was negative for indirect hemagglutination tests of the patient for Echinococcus and cysticercosis. Eosinophilia was not detected in the peripheral blood smear. Casoni skin test was negative. Based on these findings, the patient was diagnosed as primary vitreous cyst. The presented case had few symptoms, so it was decided to follow the patient without any treatment.
Figure 1: Free-floating cyst in vitreous cavity

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  Discussion Top


Free-floating vitreous cyst was first described by Tansley in 1899.[2] Vitreous cysts are classified into two groups either congenital or acquired. Congenital cysts are believed to be remnants of the primary hyaloid system and can be pigmented or nonpigmented.[3] These cysts are usually nonpigmented, with a smooth surface, pedunculated or sessile, and located anterior to the optic disc. Some congenital cysts can be limited in movement due to vitreous strands that link them to the optic discs.[4] Acquired cysts are mostly associated with inflammations due to intraocular infections such as parasitic vitritis, toxoplasmosis and uveitis or retinitis pigmentosa, choroidal atrophy, and retinoschisis.[5]

Awan in 1975 reported trauma as cause of vitreous cyst in 2.7% of his cases.[6] Trauma may trigger the vitreous cyst formation or dislocate an already formed cyst though the role of trauma remains unclear.[7]

Idiopathic vitreous cysts were reported in adult patients in literature with no or few symptoms,[8],[9] but in our case, the cyst was presented in early childhood never reported before with few symptoms and that was solitary pigmented with smooth surface probably arising as a choristoma of pigmented ciliary epithelium.

Orellana et al. had described the electron microscopic features of vitreous cyst and hypothesized that the origin of cysts was from pigment epithelium secondary to trauma.[10] Nork and Millecchia detected pigmented epithelial type tissue with immature melanosomes on histopathological examination and position at Cloquet canal which favored the hypothesis that it is choristoma of the primary hyaloid system.[11]

Visually symptomatic vitreous cysts may require interventions. Argon laser photocystotomy is simple and safe method but may expose the patient to the risk of secondary inflammation and epiretinal membrane formation due to dispersion of pigmented cells. Surgical aspiration of cyst through pars plana approach allows the cyst to collapse and overcome the risk of late complications of dispersed pigmented cells.[12]

In the presented case, the patient was mildly symptomatic, so we decided to follow up with the patient to monitor the cyst and not to provide any treatment.


  Conclusion Top


Intravitreal cysts are rare ophthalmological disorders that rarely reported in a young child with few symptoms and have been discussed for a century, but the treatment of these “ocular curiosities” remains debatable.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Bowling B. Kanski's Clinical Ophthalmology. 8th ed. China: Elsevier; 2015. p. 366-8.  Back to cited text no. 1
    
2.
Tansley JO. Cyst of the vitreous. Trans Am Ophthalmol Soc 1899;8:507-9.  Back to cited text no. 2
    
3.
Steinmetz RL, Straatsma BR, Rubin ML. Posterior vitreous cyst. Am J Ophthalmol 1990;109:295-7.  Back to cited text no. 3
    
4.
Duke-Elder S. Normal and abnormal development. Part 2. Congenital deformities. System of Ophthalmology. Vol. 3. London: Henry Kimpton; 1964. p. 763.  Back to cited text no. 4
    
5.
Bayraktar Z, Kapran Z, Ozdogan S. Pigmented congenital vitreous cyst. Eur J Ophthalmol 2004;14:156-8.  Back to cited text no. 5
    
6.
Awan KJ. Multiple free floating vitreous cysts with congenital nystagmus and esotropia. J Pediatr Ophthalmol 1975;12:49-53.  Back to cited text no. 6
    
7.
Wolter JR, Martony CL, Smith C. A free-floating vitreous cyst in the otherwise normal eye of a young man. J Pediatr Ophthalmol 1975;12:243-5.  Back to cited text no. 7
    
8.
Gupta SR, Gupta N, Anand R, Dhawan S. Idiopathic pigmented vitreous cyst. Arch Ophthalmol 2012;130:1494-6.  Back to cited text no. 8
    
9.
Lavric A, Urbancic M. Floating vitreous cyst: Two clinical cases. Case Rep Ophthalmol 2013;4:243-7.  Back to cited text no. 9
    
10.
Orellana J, O'Malley RE, McPherson AR, Font RL. Pigmented free-floating vitreous cysts in two young adults. Electron microscopic observations. Ophthalmology 1985;92:297-302.  Back to cited text no. 10
    
11.
Nork TM, Millecchia LL. Treatment and histopathology of a congenital vitreous cyst. Ophthalmology 1998;105:825-30.  Back to cited text no. 11
    
12.
Al-Kahtani E, Alkatan HM. Surgical treatment and histopathology of a symptomatic free-floating primary pigment epithelial iris cyst in the anterior vitreous. Middle East Afr J Ophthalmol 2011;18:331-2.  Back to cited text no. 12
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