Project description:Introduction and importanceCongenital iris and choroidal coloboma is a congenital ocular developmental anomaly, most occur in both eyes, which may exist in isolation or be accompanied by systemic developmental abnormalities. Herein, we report a case of congenital bilateral coloboma of iris and choroid accompanied by unilateral multiple primary pigmented iris cysts. The selection of treatment methods for iris cysts has always been a challenge for ophthalmologists. Especially for primary iris pigment epithelial cysts without clinical symptoms, no particular intervention measures are required. Which in turn helps ophthalmologists to make clinical decisions in real-world practice.Case presentationA 16-year-old boy presented to the ophthalmology clinic with a history of poor eyesight in both eyes since childhood. The pupils of both eyes were pear shaped, and there was a pigmented iris cyst about 1.5 mm × 2 mm at 6-7 o'clock pupillary margin of the left eye on slit-lamp examination. A large fan-shaped coloboma of choroid in both eyes respectively, involving the optic nerve and macular area on fundus examination. Ultrasound biomicroscopy revealed three cysts with hyperreflective walls and clear hyporeflective lumen in the left eye, one located on the anterior surface of the iris and the other two located on the posterior surface of the iris. Above all, he had no history of surgery, trauma, infection, tumor or medication. Therefore, primary pigmented iris epithelial cysts were diagnosed. Given that the patient was asymptomatic, with no impact on visual function, his cysts were monitored. After 2 years follow-up, the cysts remained stable.Clinical discussionIris cysts, whether primary or secondary, are a diagnostic and a treatment challenge. Primary iris cysts are mostly present in the iridociliary sulcus and the ciliary crown, often asymptomatic, with a few located forward or larger, manifested as local protrusions around the iris. This patient had no history of ocular surgery or trauma, therefore, combining clinical manifestations and imaging examination results, primary pigmented iris epithelial cysts were diagnosed. For this patient, on the one hand, the surgical risk was high, and iris cysts probably recur after surgery, and there might be no improvement in postoperative visual acuity. On the other hand, the patient's fundus was poor and his family's economic conditions were not good. In addition, the iris cysts of this patient remained stable after 2 years of observation, therefore, no treatment was taken.ConclusionOphthalmologists should be aware of this rare but distinctive presentation, especially in patients without symptoms. Prompt diagnosis and treatment are pivotal in ensuring favorable outcomes and preventing further ocular complications in individuals affected by these uveal anomalies.

Project description:Case series purposeIris cysts are uncommon lesions, most of them are iris pigment epithelial (IPE) cysts which typically manifest in adults as unilateral single cysts, are typically asymptomatic and rarely require treatment. The most frequent location of IPE cysts is the iris periphery and the iridociliary sulcus, whereas pupillary cysts are rare. This observational case series aims to describe a unique occurrence of bilateral pupillary IPE cysts in three consecutive generations of a single family.ObservationsThe series describes eight patients of a single family with no consanguineous marriage. All patients have IPE cysts with remarkable abnormally-shaped pupils. The patients were examined at the slit-lamp and imaged with anterior segment optical coherence tomography. Three brothers (14, 19 and 28 years old) were symptomatic and suffered from hemeralopia and reduced visual acuity. ND-YAG laser was successful in relieving the symptoms in the two younger brothers. No recurrence or refill of the cysts occurred after laser application and no intra- or ppostoperative complications were observed during a 9-month follow-up. The older family members showed spontaneously shrunken IPE cysts.Conclusions and importanceIPE cysts are considered idiopathic with an unclear origin. The rare familial incidence of the cysts suggests an autosomal dominant heredity pattern. Many theories were proposed to explain the origin of cysts and none is conclusive. Their principal clinical significance is their similarity to pigmented iris tumors, but they might also cause visual symptoms. Treatment modalities vary from less invasive chemical compounds and ND: YAG laser application to more invasive surgical procedures with disparate efficacy and safety. In the case of multiple cysts, examination of other family members is worthy even when asymptomatic and cardiac consultation of affected patients is warranted as IPE cysts may proclaim a coexisting cardiovascular abnormality, such as familial aortic dissection.

Project description:BackgroundIris cysts in horses are often asymptomatic and noticed incidentally. However, cysts can cause local corneal oedema and erratic behaviour like shying, decreased performance and head-shaking.ObjectivesTo describe the use of diode laser as a noninvasive treatment option for iris cysts in the horse and to document factors influencing its efficacy, associated complications, long-term outcome and rate of recurrence.Study designRetrospective case series.MethodsCase records of horses treated for iris cysts by diode laser at the Utrecht University Equine Clinic were reviewed between 2008 and 2020. Diagnosis was based on ophthalmic and ultrasonographic evaluation. Long-term follow-up was obtained in two phases, a telephone survey with the owner and a photographic re-evaluation of the treated eyes.ResultsThirty-five horses were included, with a total of 46 eyes treated. One day after diode laser treatment (short-term), 35/46 treated eyes had a good decrease in cyst size, 7/46 had a moderate effect, 1/46 had a minimal effect, 1/46 had no effect, and in two cases the effect was unspecified. The decrease in size after diode laser treatment in polycystic eyes (odds ratio [OR] 0.381, 95% CI 0.1530-0.724), p = 0.001), thick-walled cysts (OR = 0.139; CI = 0.023-0.726, p = 0.02) and hyperplastic corpora nigra (OR = 0.081; CI = 0.004-0.528, p = 0.03) was significantly less satisfactory, with ORs of 0.381, 0.139 and 0.081, respectively. Minor complications, such as mild reactive uveitis, were reported in 8/46 (17%) eyes. On long-term follow-up (median 19 months; IQR 25.5), clinical signs had diminished or disappeared in most cases (93%) and 83% of the owners would recommend the treatment. Based on long-term photographic re-evaluation (median 32.5 months; IQR 49.75), 2/16 cases of recurrence were seen.Main limitationsRetrospective design, follow-up by telephone questionnaire and photographic re-evaluation. Loss to follow-up in the photographic re-evaluation.ConclusionsBoth short- and long-term results indicate diode laser treatment is a useful and safe option for iris cyst size reduction, with a low risk of recurrence. Presurgical ultrasonography is recommended to assess the feasibility of treatment and to allow for better surgical planning.

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Pigmented free‐floating iris cysts

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