Pigmented mobile vitreous cyst with cystoid macular edema in retinitis pigmentosa - A quirky association

Rushik Patel; Kushal Delhiwala; Bakulesh Khamar; Parth Rana

doi:10.4103/ijo.IJO_847_21

Users Online: 68

PHOTO ESSAY

Year : 2022 | Volume : 2 | Issue : 1 | Page : 285-286

Pigmented mobile vitreous cyst with cystoid macular edema in retinitis pigmentosa - A quirky association

Rushik Patel, Kushal Delhiwala, Bakulesh Khamar, Parth Rana
Department of Vitreo Retina, Netralaya Superspeciality Eye Hospital, KD House, 1^st Floor, Above Andhra Bank, Parimal Cross Roads, Ellisbridge, Ahmedabad, Gujarat, India

Date of Submission	13-Apr-2021
Date of Acceptance	03-Jul-2021
Date of Web Publication	07-Jan-2022

Correspondence Address:
Dr. Kushal Delhiwala
Department of Vitreo Retina, Netralaya Superspeciality Eye Hospital, KD House, 1^st Floor, Above Andhra Bank, Parimal Cross Roads, Ellisbridge, Ahmedabad - 380 006, Gujarat
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_847_21

Abstract

Keywords: Cystoid macular edema, pigmented vitreous cyst, retinitis pigmentosa

How to cite this article:
Patel R, Delhiwala K, Khamar B, Rana P. Pigmented mobile vitreous cyst with cystoid macular edema in retinitis pigmentosa - A quirky association. Indian J Ophthalmol Case Rep 2022;2:285-6

How to cite this URL:
Patel R, Delhiwala K, Khamar B, Rana P. Pigmented mobile vitreous cyst with cystoid macular edema in retinitis pigmentosa - A quirky association. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Aug 14];2:285-6. Available from: https://www.ijoreports.in/text.asp?2022/2/1/285/334982

A 50-year-old female presented with blurring of vision in the right eye (OD) for the past 2 months. On examination, best-corrected visual acuity was 20/200 and 20/30 in OD and left eye, (OS) respectively. Slit-lamp evaluation of both eyes was unremarkable except posterior subcapsular cataract (OD > OS). Right eye fundus evaluation revealed a solitary, oval-shaped, smooth, and free-floating pigmented vitreous cyst (P-VC) in periphery, without signs of inflammation [Figure 1]a, [Figure 1]b, [Figure 1]c. The cyst was appreciated better using the red channel of pseudocolor ultra-widefield retinal imaging system (UWF-RIS; Optos, UK). Additionally, both eyes fundus showed waxy pale disc, attenuated retinal blood vessels, and bone spicule pigmentation in mid periphery, suggestive of typical retinitis pigmentosa (RP). Swept-source optical coherence tomography (DRI-OCT Triton plus, Topcon medical systems Inc., Oakland, NJ, USA) showed cystoid macular edema (CME) without associated epiretinal membrane (ERM) in OD [Figure 1]d. Ultrasonography (USG) of P-VC showed an approximate size of 3 mm × 2.2 mm with irregular internal echoes and hyperechogenic borders on A-scan vector overlay [Figure 1]e.

Figure 1: (a) Ultra-widefield pseudocolor fundus photo of the right eye showing pigmented vitreous cyst (white arrow) and signs of retinitis pigmentosa. (b) Fundus photo showing movement of vitreous cyst from 5 o'clock hours to 3.5 o'clock hours (white arrow). (c) Magnified image of pigmented vitreous cyst. (d) Swept-source optical coherence tomography scan of the right eye showing cystoid macular edema. (e) B-scan ultrasonography of right eye vitreous cyst (asterisk) showing irregular internal echoes and hyperechogenic borders on A-scan vector overlay (+signs)

Click here to view

Discussion

Pigmented mobile vitreous cyst having irregular internal echoes, along with concurrent CME without ERM in RP, has not been described to the best of our knowledge.

In Tan et al.'s^[1] study of 2127 eyes with RP, ERM (709) and CME (255) were common. None had a vitreous cyst. Yoshida et al.^[2] found non-pigmented vitreous cysts in 37 of 867 eyes with RP. Of these, only two eyes had CME with ERM.

Vitreous cysts, including P-VCs, are known to have characteristic internal anechoic centers and hyperechoic borders on USG.^[3],[4] In contrast, our patient with P-VC had irregular internal echoes.^[5]

Clinically, vitreous cysts with RP moved slightly on ocular motion.^[2] However, we could capture the gross mobility of the vitreous cyst during serial follow-ups with the help of pseudocolor UWF-RIS. Asymptomatic vitreous cysts, in general, rarely require intervention.

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

1.	Tan L, Long Y, Li Z, Ying X, Ren J, Sun C, et al. Ocular abnormalities in a large patient cohort with retinitis pigmentosa in Western China. BMC Ophthalmol 2021;21:43.
2.	Yoshida N, Ikeda Y, Murakami Y, Nakatake S, Tachibana T, Notomi S, et al. Vitreous cysts in patients with retinitis pigmentosa. Jpn J Ophthalmol 2015;59:373-7.
3.	Mohan S, Rajan M. Vitreous cyst in a 13-year-old girl. Indian J Ophthalmol Case Rep 2021;1:18. [Full text]
4.	Dogra M, Rana V, Gautam N. Multimodal imaging of a pigmented vitreous cyst. Ophthalmology 2021;128:27.
5.	Frasson M, de Queiroz AC, Lino BT, Nehemy MB. [Vitreous cyst and retinitis pigmentosa: Case report]. Arq Bras Oftalmol 2010;73:179-81.