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 Table of Contents  
OPHTHA INSTA
Year : 2021  |  Volume : 33  |  Issue : 1  |  Page : 12-13

Asymptomatic iris cyst encroaching anterior chamber angle


1 Cornea, External Diseases and Refractive Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India
2 Pediatric and Squint Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India
3 Uvea Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India

Date of Submission18-Jun-2020
Date of Acceptance26-Jun-2020
Date of Web Publication19-Apr-2021

Correspondence Address:
Dr. Kirandeep Kaur
Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kjo.kjo_84_20

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How to cite this article:
Gurnani B, Kaur K, Balamurugan S. Asymptomatic iris cyst encroaching anterior chamber angle. Kerala J Ophthalmol 2021;33:12-3

How to cite this URL:
Gurnani B, Kaur K, Balamurugan S. Asymptomatic iris cyst encroaching anterior chamber angle. Kerala J Ophthalmol [serial online] 2021 [cited 2021 May 7];33:12-3. Available from: http://www.kjophthal.com/text.asp?2021/33/1/12/314106



A 70-year-old male presented with complaints of diminution of vision in both eyes (OU) for the past 6 months. Best-corrected visual acuity was 20/80 OU. Intraocular pressure was 16 mmHg and 14 mmHg in the right eye (oculus dextrus) and left eye (oculus sinister), respectively. Anterior segment examination in OD revealed normal anterior chamber, primary mid zonal iris pigment epithelial (IPE) cyst[1] extending from 7 to 10 o'clock and grade 2 nuclear sclerotic cataract [Figure 1]a. Fundoscopy revealed 0.4:1 Cup disc ratio and rest was within normal limits. Gonioscopy in OD revealed open angles with iris cyst encroaching the nasal, superior, and inferior angle [Figure 1]b,[Figure 1]c,[Figure 1]d. There was no ectropion, corectopia, any feeder, or intrinsic blood vessels as often observed with melanoma.[2] The patient was diagnosed as iris cyst with grade 2 nuclear sclerotic cataract. The patient was advised ultrasound biomicroscopy (UBM) to rule out ciliary body involvement and follow-up with reports. On UBM, IPE cyst shows a very thin wall with absent reflectivity while melanoma is centrally dense with vascular pulsations, and arises from the uveal structures.[3] Meticulous examination with close follow-up is mandatory as IPE cyst can progressively infiltrate anterior chamber angle and manifest with acute angle closure.[4],[5]
Figure 1: Image depicting (a) primary mid zonal iris pigment epithelial cyst extending from 7 to 10 o'clock (white arrowhead) and grade 2 nuclear sclerotic cataract (b) gonioscopic image of the nasal angle of the right eye depicting infiltration of iris cyst in anterior chamber angle (black arrowhead) (c) gonioscopic image of the superior angle of the same eye depicting iris cyst encroaching the angle with abutting ciliary body band (black arrowhead) (d) gonioscopic image of the inferior angle of the same eye depicting iris cyst approaching the angle (white arrowhead)

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Clinical sign – Primary mid zonal IPE cyst extending with grade 2 nuclear sclerotic cataract.

Seen in[1]

  1. Primary cysts-idiopathic-iris pigment epithelium cysts, iris stromal cysts
  2. Secondary cysts-epithelial downgrowth-postsurgical, posttraumatic, cysts secondary to intraocular tumors-iris melanoma, medulloepithelioma
  3. Medication-induced-miotics (phospholine iodide), prostaglandins
  4. Cysticercosis infection.


Described by – Mackenzie diagnosed the first iris cyst in 1830.[3]

Why it occurs – The pathogenesis of primary iris cysts is not entirely understood, and proposed mechanisms are controversial. IPE cysts are thought to be remnants of the marginal sinus of the iris that have not been obliterated. The presence of goblet cells in iris stromal cysts suggest that they are formed by entrapped surface ectoderm tissue likely during formation of the lens vesicle (4th week of embryogenesis).[1],[3]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Shields JA, Shields CL, Lois N, Mercado G. Iris cysts in children: Classification, incidence, and management. The 1998 Torrence A Makley Jr Lecture. Br J Ophthalmol 1999;83:334-8.  Back to cited text no. 1
    
2.
Mayro EL, Surakiatchanukul T, Shields JA, Shields CL. Distinguishing midzonal iris pigment epithelial cyst from adenoma and ciliary body melanoma. Oman J Ophthalmol 2018;11:161-3.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Shields JA, Shields CL. Intraocular Tumors: An Atlas and Textbook. 3rd ed. Philadelphia, PA: Lippincott Wolters Kluwer; 2015. pp. 51-192.  Back to cited text no. 3
    
4.
Vila-Arteaga J, Díaz-Céspedes RA, Suriano MM. Plateau iris secondary to iridociliary cysts. Arch Soc Esp Oftalmol 2015;90:542-5.  Back to cited text no. 4
    
5.
Wang BH, Yao YF. Effect of primary iris and ciliary body cyst on anterior chamber angle in patients with shallow anterior chamber. J Zhejiang Univ Sci B 2012;13:723-30.  Back to cited text no. 5
    


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