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PHOTO ESSAY
Year : 2021  |  Volume : 1  |  Issue : 4  |  Page : 816-817

Clinical presentation and management of spontaneous ciliary body cysts with secondary angle closure: A report of three cases


Department of Glaucoma, Aravind Eye Hospital and Postgraduate Research Institute, Madurai, Tamil Nadu, India

Date of Submission18-Feb-2021
Date of Acceptance13-Jun-2021
Date of Web Publication09-Oct-2021

Correspondence Address:
Dr. R Sharmila
Department of Glaucoma, Aravind Eye Hospital and Postgraduate Research Institute, Anna Nagar, Madurai - 625 020, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_420_21

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  Abstract 


Keywords: Angle closure glaucoma, ciliary body cysts, ultrasound biomicroscopy


How to cite this article:
Sharmila R, Shreya TS, Senthilkumar VA. Clinical presentation and management of spontaneous ciliary body cysts with secondary angle closure: A report of three cases. Indian J Ophthalmol Case Rep 2021;1:816-7

How to cite this URL:
Sharmila R, Shreya TS, Senthilkumar VA. Clinical presentation and management of spontaneous ciliary body cysts with secondary angle closure: A report of three cases. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Oct 18];1:816-7. Available from: https://www.ijoreports.in/text.asp?2021/1/4/816/327690



Iris and ciliary body cysts are a rare cause of angle-closure glaucoma with varied presentation. Here we discuss three cases of iridociliary cysts with varied presentation of angle closure best identified by ultrasound biomicroscopy (UBM) that required different management modalities.

Case 1: A 27-year-old male was referred for high intraocular pressure (IOP) in his right eye. His best-corrected visual acuity (BCVA) was 20/20 in both eyes (OU) and IOP was 28 mmHg in right eye (OD), 20 mmHg in left eye (OS). Anterior segment and gonioscopy evaluation OU revealed variable chamber depth and multiple elevated areas of peripheral iris that approached the trabecular meshwork in less than 180° angle with no synechiae or aberrant vessels, respectively. UBM OU showed multiple thin-walled ciliary body cysts with no internal reflectivity [Figure 1]a and [Figure 1]b. Optic disc examination OU was unremarkable. As the patient was asymptomatic with cysts involving less than 180° angle with no glaucomatous optic disc damage, he was managed conservatively with timolol 0.5% (timolol maleate) eye drops twice a day in OD for high IOP and OS was observed without the use of any IOP lowering agents.
Figure 1: (a) UBM images showing multiple thin-walled ciliary body cysts (white arrows) with no internal reflectivity in OU, (b) magnified image of the same showing multiple elevated areas of peripheral iris approaching the angle structures (white arrowheads)

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Case 2: A 28-year-old female was referred for irregular depth of the anterior chamber. Her BCVA OU was 6/6 and IOP in OD was 15 mmHg and OS 14 mmHg. Anterior segment and fundus examination OU were normal. Gonioscopy showed open angles in OU with few areas of iris convexities. UBM OU showed thin-walled ciliary body epithelial cysts [Figure 2]a and [Figure 2]b with no internal reflectivity. Due to its benign nature, we closely observed the patient with serial follow-up with UBM every 3-4 months.
Figure 2: (a) UBM images showing thin-walled ciliary epithelial cysts (white arrows) with no internal reflectivity with open angles (white arrowheads), (b) magnified image showing thin-walled ciliary epithelial cyst (white arrow)

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Case 3: A 45-year-old female presented with complaints of headache and intermittent blurring of vision in OD. Her BCVA was 6/9 in OD and 6/6 in OS. IOP was 60 mmHg OD and 18 mmHg OS. Anterior segment examination revealed a variable anterior chamber (AC) depth in OD with multiple elevated areas or iris surface and a normal fellow eye. Fundus examination showed a cup-to-disc ratio (CDR) of 0.9 in OD and 0.5 CDR in OS. Gonioscopy revealed synechially closed angles in OD and open angles in OS. UBM OD revealed 360 degrees irido-ciliary cysts [Figure 3]a and [Figure 3]b. Visual field analysis OD by Humphreys field revealed split fixation on 10-2 strategy. She was started on oral (T. acetazolamide 250 mg three times a day) and topical (timolol maleate 0.5% twice daily (BD) + brimonidine tartrate 0.2% BD, dorzolamide hydrochloride 2% Thrice a day (TID), latanoprost 0.005% night time [HS]) IOP lowering agents and underwent sequential argon laser iridoplasty followed by micropluse G6 in view of advanced angle-closure glaucoma in OD. At one-month follow-up, the IOP OD remained stable with three IOP lowering agents.
Figure 3: (a) UBM images showing iridociliary cysts (white arrow), (b) peripheral anterior synechiae (white arrowhead) due to large ciliary body (CB) cyst (white arrow)

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  Discussion Top


Iridociliary cysts can be primary or secondary. Primary cysts occur spontaneously and secondary cysts may be due to malignancy, penetrating injury, parasitic infection, or after long term use of miotics or latanoprost eyedrops.[1],[2],[3] Iris-ciliary body cysts are generally asymptomatic and do not require treatment except in rare cases involving the visual axis or anterior chamber angle. Various treatment modalities described in the literature are sector iridotomy, puncture of cysts, and laser iridoplasty by argon and Nd: Yag lasers.[4]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names 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.
Lois N, Shields CL, Shields JA, Mercado G. Primary cysts of the iris pigment epithelium. Clinical features and natural course in 234 patients. Ophthalmology 1998;105:1879-85.  Back to cited text no. 1
    
2.
Tanihara H, Akita J, Honjo M, Honda Y. Angle closure caused by multiple, bilateral iridociliary cysts. Acta Ophthalmol 1997;75:216-7.  Back to cited text no. 2
    
3.
Azuara-Blanco A, Spaeth GL, Araujo SV, Augsburger JJ, Terebuh AK. Plateau iris syndrome associated with multiple ciliary body cysts. Report of three cases. Arch Ophthalmol 1996;114:666-8.  Back to cited text no. 3
    
4.
Kuchenbecker J, Motschmann M, Schmitz K, Behrens-Baumann W. Laser iridocystotomy for bilateral acute angle-closure glaucoma secondary to iris cysts. Am J Ophthalmol 2000;129:391-3.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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