Secondary glaucoma associated with bilateral complete ring cysts of the ciliary body

Long-term Follow-up of 14 Eyes With Bilateral and Multiple Ciliary Body Cysts: Prognosis of this Rare Entity

PURPOSE

To describe the long-term outcomes of eyes with bilateral and multiple ciliary body cysts (CBC).

METHODS

This retrospective study included patients with multiple and bilateral CBC diagnosed by high-resolution ultrasound biomicroscopy and followed by a single glaucoma specialist from 2000 to 2020. All patients underwent complete ophthalmic examination including dynamic indentation gonioscopy, retinal nerve fiber layer (RNFL) measurement by optic coherence tomography and automated perimetry.

RESULTS

Seven patients (14 eyes) with bilateral and multiple CBC were included with a mean follow-up of 98±39 months. Four eyes of 2 patients had complete angle closure at first examination and 3 of them underwent trabeculectomy with good visual outcomes. Four eyes of 2 patients had a reversible angle-closure at first examination and underwent a ultrasound biomicroscopy-guided laser peripheral iridotomy (LPI) which reopened the irido-corneal angles. Two of these eyes needed intensification of hypotensive drops during the follow-up. Among the 6 eyes (3 patients) with open angle at first examination, all had had LPI at last follow-up visit, 5 had normal RNFL and visual field and 1 received an additional hypotensive drop because of RNFL progression.

CONCLUSION

Our long-term cohort of bilateral and multiple CBC demonstrates that this rare entity may have a good prognosis if LPI is performed before extension of peripheral anterior synechiae. Irreversible angle closure required trabeculectomy in 75% of cases in our cohort with however good visual outcomes.

Anterior vitrectomy, phacoemulsification cataract extraction and irido-zonulo-hyaloid-vitrectomy in protracted acute angle closure crisis

Purpose

To describe a modified surgical approach with anterior vitrectomy, phacoemulsification (phaco) cataract extraction and irido-zonulo-hyaloid-vitrectomy (IZHV) in protracted acute angle closure crisis (AACC).

Patients and methods

Non-comparative, retrospective case series including 21 eyes in 19 consecutive cases of protracted AACC, which persists for at least 7 days despite maximal medical and laser therapies, were included in this study. All patients underwent a modified surgical procedure with anterior vitrectomy, phaco cataract extraction, IOL implantation, goniosynechialysis (GSL) and IZHV, using modest phaco dynamic parameters with intraocular pressure (IOP) set at 30 mmHg through the procedure using Centurion® Vision System equipped with active fluidics while the anterior vitrectomy was set at 4000 or 5000 rpm. IOP and anterior chamber space were maintained through the procedure using ophthalmic viscosurgical device (OVD) injected through paracentesis whenever the Phaco or I/A probe was withdrawn from within the anterior chamber. Medical history, visual acuity (VA), IOP and anterior and posterior segment findings were recorded and compared before and after surgical treatment.

Results

The average age of all patients was 60.05 years old, while the average period of persistent AACC was 20.05 days. Preoperatively, the average IOP of all included eyes was 44.40 ± 8.42 mmHg despite maximal topical and systemic anti-glaucoma medications and/or laser surgeries, while the average VA was 1.46 ± 0.88 (log MAR). Postoperatively, IOP was well controlled in all patients with an average IOP at 12.06 ± 3.07 mmHg without any anti-glaucoma medications at follow-ups, which was decreased significantly from that in preoperative measurements (P < 0.001). Visual acuity was improved significantly at final follow-up with an average postoperative VA at 0.74 ± 0.77 (log MAR, P < 0.001). Anterior segment inflammation was surprisingly mild with no or minimal inflammatory cells or exudates. Anterior segment configuration was resolved in all the cases. There was no recurrent IOP spike, anterior chamber shallowing or severe complications during an average follow-up of 5.38 months (ranging from 3 to 6 months).

Conclusions

Protracted AACC is a complex situation while a modified surgical strategy of anterior vitrectomy, phaco cataract extraction and IZHV provides a safe and efficient solution.

Clinical observations of iridociliary cysts and their changes after implantable collamer lens implantation in myopic patients

AIM

To observe the characteristics of iridociliary cysts in myopic patients and evaluate the influences on the position and safety of implantable collamer lens (ICL) after surgery.

METHODS

Totally 270 eyes of 135 patients who underwent ICL surgery for the corrections of myopia were included in this study. Preoperative and postoperative morphology of iridociliary cysts were observed in ultrasonic biomicroscopy (UBM) image.

RESULTS

A total of 138 iridociliary cysts were found in 88 eyes of 50 patients among 270 eyes of 135 patients before surgery (37%). Twenty-five patients had cysts in one eye (50%) and 25 had cysts in both eyes (50%). The prevalence of iridociliary cysts was negatively correlated with age, but no gender difference (P>0.05). The incidence of iridociliary cysts was much less in eyes with myopia greater than -9.00 D (P<0.05). The diameter of the largest cyst was 1.96 mm and the smallest cyst was 0.24 mm, with a majority within the range of 0.5 to 1.0 mm. Most of the cysts were located in the inferior temporal quadrant. One year after ICL implantation, 51 iridociliary cysts (37%) remained unchanged, 47 cysts (34%) decreased in size, and 40 cysts (29%) disappeared. Most of cysts that changed after surgery were smaller than 1.0 mm (P<0.05) and located in the nasal and temporal sides around the haptics of implantable lens. All the ICL were in their original position.

CONCLUSION

Iridociliary cysts are commonly seen in myopic eyes. The cysts have no impact on the safety of ICL surgery. Some cysts may decrease in size or disappear after ICL implantation.

Implantable collamer lens surgery in patients with primary iris and/or ciliary body cysts

BACKGROUND

The prevalence of primary iris and/or ciliary body cysts is common in myopia, though asymptomatic in nearly all cases. It's a very valuable thing to study the clinical safety and reliability of implantable collamer lens (ICL) surgery in patients with primary iris and/or ciliary body cysts.

METHODS

A total of 108 patients (201 eyes) were included in this retrospective study. All eyes had been implanted with V4c implantable collamer lens (ICLV4c). According to the eyes with or without primary iris and/or ciliary body cysts, all eyes were divided into two groups. We observed preoperative and postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity)(CDVA), intra-ocular pressure(IOP), anterior chamber volume(ACV), anterior chamber depth(ACD), trabecular-iris angle (TIA), angle opening distance at 500 μm (AOD500),vertical central distance between the corneal endothelium and the front surface of ICL(CE-ICL), and the central vault. The follow-up periods covered 12 months.

RESULTS

Among all the 201 eyes, primary iris and/or ciliary body cysts were detected in 54 eyes (26.87%),but the prevalence was account to 36.11%(18males,21females).There were 30 eyes (55.56%) with unilateral single cyst, 12 eyes (22.22%) with unilateral double cysts, 12 eyes (22.22%) eyes with unilateral multiple and/or multi-quadrants cysts, the mean size of cysts was (0.714 ± 0.149)mm(range from 0.510 to 1.075 mm).30.4% of the cysts were located at iridociliary sulcus, 65.5% in pars plicata, and 4.1% in midzonal iris, which showed a characteristic distribution pattern, with cysts found predominantly in the inferior and temporal quadrants.The postoperative size and the number of cysts showed nearly no changes. The postoperative ACV, AOD500 and TIA showed a statistical reduction in both two groups (P < 0.05), but with no statistical significant between the two groups (P > 0.05), the parameters of postoperative IOP,CE-ICL and central vault also showed the same results as which. We did not observe serious complication and IOP elevating in the whole follow-up periods.

CONCLUSION

Primary iris and/or ciliary body cysts are not absolutely contraindication for ICL surgery. For some single cyst smaller than 1.075 mm or single quadrant cysts located at ciliary body are rare to lead some serious complications. But, for some multiple cysts, especially multi-quadrants cysts located at iridociliary sulcus, we still should remain cautions.

Iridociliary cysts do not impact on posterior phakic intraocular lens implantation for high myopia correction: A prospective cohort study in 1569 eyes

Purpose

To investigate the clinical characters and effect of iridociliary cysts among patients who had undergone posterior phakic intraocular lens implantation.

Methods

A total 1569 eyes of 866 high myopia patients, who underwent phakic intraocular lens implantation from 1 September 2011 to 31 August 2016, was included in this prospective cohort study. These patients were followed up for more than 12 months postoperatively.

Results

During the study period, 218 eyes (14%) of 154 patients were diagnosed with iridociliary cysts by ultrasound biomicroscopy. There were 74.3% patients with unilateral cysts and the cysts tended to have occurred in patients ages 20 to 30 years old (22%). The location of the cysts varied with temporal position as the most (50%) and superior position as the least (9.6%). After 1 week postoperative follow-up, there were no significant differences in clinical outcomes between the cysts group and no cysts group, but the proportion of 20/20 or better uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and the 2 types of vector astigmatism. Intraocular pressure (IOP), refraction, and vault remained stable at different time points of the follow-up period, while vault of cysts patients tend to be lower than patients without cysts at more than 12 months.

Conclusions

Iridociliary cysts were more common than estimated and it had no impact on Phakic Intraocular Lens implantation because there was no clue to show significantly difference on postoperative clinical outcomes between the patients with and without iridociliary cysts in this study.

Circumferential Ciliary Body Cysts Presenting as Acute Pigment Dispersion and Ocular Hypertension

PURPOSE

To report a case of circumferential neuroepithelial cyst of the ciliary body presenting with pigment dispersion (PD) and ocular hypertension.

CASE REPORT

48-year-old female patient presented with a complaint of pain in the left eye. On examination, visual acuity of the left eye was 0.9, and the intraocular pressure was 48 mmHg. Biomicroscopic anterior segment examination of the left eye revealed 4+ pigmented cells in the anterior chamber. Active PD from the pupillary region at 11 o'clock was noticed at the time of the examination. Ultrasound biomicroscopy demonstrated 360º cystic lesions of the ciliary body in the left eye. The patient was diagnosed as neuroepithelial cyst of the ciliary body.

CONCLUSION

Our case is unique as it is the first case of circumferential neuroepithelial ciliary body cyst presenting with acute PD and ocular hypertension.

Pupillary block due to reverse implantation of a sulcus intraocular lens

An 88-year-old woman with a history of complicated cataract extraction by phacoemulsification with sulcus intraocular lens (IOL) placement developed pseudophakic pupillary block after reverse implantation of the IOL. In the postoperative period, she had persistently elevated intraocular pressures (IOP) and was diagnosed with chronic angle-closure glaucoma that was treated medically. She presented 5 years later with acute pupillary block. The diagnosis of reverse IOL implantation was confirmed by ultrasound biomicroscopy. An IOL repositioning, anterior synechialysis, and Baerveldt tube shunt placement led to resolution of the pupillary block and a well-controlled IOP.