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PHOTO ESSAY
Year : 2022  |  Volume : 2  |  Issue : 1  |  Page : 269-270

Traumatic cataract with iris cyst - A combined approach


Department of Cornea and Refractive Surgeries, Sankara Eye Hospital, Guntur, Andhra Pradesh, India

Date of Submission18-May-2021
Date of Acceptance27-Aug-2021
Date of Web Publication07-Jan-2022

Correspondence Address:
Dr. Monica Budhwani
Department of Cornea and Refractive Surgeries, Sankara Eye Hospital, Guntur - 522 509, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1260_21

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How to cite this article:
Budhwani M, Potti S. Traumatic cataract with iris cyst - A combined approach. Indian J Ophthalmol Case Rep 2022;2:269-70

How to cite this URL:
Budhwani M, Potti S. Traumatic cataract with iris cyst - A combined approach. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Jan 23];2:269-70. Available from: https://www.ijoreports.in/text.asp?2022/2/1/269/334863



Epithelial iris cysts can be primary or secondary based on etiology.[1] Deposition of surface epithelial cells on the iris following penetrating injury result in implantation cysts, which are classified as solid pearl lesions, epithelial fluid-filled cysts, and epithelial ingrowth.[2]

A 24-year male presented 5 years ago with redness in the left eye and had history of corneal tear repair 5 years prior. Visual acuity was 6/9, N6 with iris cyst adjacent to pupil and corneal scar nasally. Six months later, the cyst increased in size and was covering the visual axis [Figure A]. UBM showed splitting of iris layers attached to cornea anteriorly and lens capsule posteriorly [Figure B]. Cyst showed internal echolucency. The patient was advised cataract + PKP but was not willing. Three years later, he presented with mature cataract and iris cyst adherent to cornea [Figure C], endothelial cell density of 1148.4/mm2 with 42% hexagonality with poor quality images. The patient was reluctant for keratoplasty; thus, cystectomy + cataract surgery was planned, with the possibility of corneal decompensation and cyst recurrence explained. Phacoemulsification with lens in bag was done, aspiration of the cyst with a 30-G needle (bevel up) attached to a 3-way valve and 2-ml syringe, followed by infusion of absolute alcohol from a separate syringe through the second arm of the valve (repeated twice till cyst wall appeared grey) [Figure D]. Cyst wall peeled with retinal forceps. One-month follow-up best-corrected vision was 6/6, with corneal scar nasally and no cyst recurrence [Figure E]. Endothelial cell count was 2717.4/mm2 with 39% hexagonality.
Figure A: Iris cyst adherent to the cornea with a nasal linear scar

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Figure B: UBM shows nasal iris cyst (arrow) with attachment to cornea and lens capsule

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Figure C: Iris cyst adherent to the cornea with mature cataract

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Figure D: 3-way valve attached to30-G needle and 1-ml syringe with absolute alcohol (red) and 2-ml syringe for aspiration (yellow)

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Figure E: Postoperative picture with nasal corneal scar and IOL in bag

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  Discussion Top


Surgical management of iris cysts described in the literature involves extensive surgery with excessive surgical excision and devitalization of adjacent tissues.[3] Management with absolute alcohol was described by Behrouzi et al.[4] and modified by Shields et al.[5] This technique is safe and effective and avoids complications of cyst rupture, glaucoma, and complications associated with tissue resection.

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.
Shields JA, Kline MW, Augsburger JJ. Primary iris cysts: A review of the literature and report of 62 cases. Br J Ophthalmol 1984;68:152-66.  Back to cited text no. 1
    
2.
Hildreth T, Maino J, Hartong T: Primary and secondary iris cysts. J Am Optom Assoc 1991;62:588–92.  Back to cited text no. 2
    
3.
Philip SS, John DR, Ninan F, John SS. Surgical management of post-traumatic iris cyst. Open Ophthalmol J 2015;9:164-6.  Back to cited text no. 3
    
4.
Behrouzi Z, Khodadoust A. Epithelial iris cyst treatment with intracystic ethanol irrigation. Ophthalmology 2003;110:1601-5.  Back to cited text no. 4
    
5.
Shields CL, Arepalli S, Lally EB, Lally SE, Shields JA. Iris stromal cyst management with absolute alcohol-induced sclerosis in 16 patients. JAMA Ophthalmol 2014;132:703-8.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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