Case Report: Cyclodialysis Cleft in a Case of Open-globe Injury and Role of Swept-source Anterior Segment Optical Coherence Tomography in Diagnosis.

SIGNIFICANCE: Cyclodialysis clefts can potentially develop secondary to open globe injury. The swept-source anterior segment optical coherence tomography (SS-AS-OCT) may be a valuable diagnostic tool for the identification and estimation of the circumferential extent of cyclodialysis clefts. It could be considered an alternative when ultrasound biomicroscopy cannot be performed successfully. PURPOSE: The purpose of this study was to report a case of open-globe injury associated with cyclodialysis cleft and the utility of SS-AS-OCT in its diagnosis. CASE REPORT: A 12-year-old boy presented to the clinic because of penetrating ocular trauma to his left eye with a projectile stone. He was diagnosed with limbal perforation with uveal tissue prolapse and cataract. He underwent limbal repair with cataract extraction and posterior chamber intraocular lens implantation. However, even at the 6 weeks' post-operative period, he did not gain vision and had persistent hypotony with hypotonic maculopathy. Gonioscopy showed a 2-clock-hour superonasal cyclodialysis cleft. However, on SS-AS-OCT, it was discovered that the cleft extended along 5 clock hours, involving both superonasal and inferonasal quadrants. Recognizing the large extent of the cleft, endocyclopexy by modified sewing-machine technique was planned and performed. An IOP spike and improvement in vision were noted on the next post-operative day. The SS-AS-OCT confirmed cleft closure. CONCLUSIONS: Although rare, cyclodialysis can occur in cases of open globe injury. The SS-AS-OCT is a useful diagnostic tool to study the circumferential extent of cyclodialysis and may unravel detachments hidden behind intact anterior ciliary body face.

[Free-Floating Intraocular Cysts]. / Frei fluktuierende intraokulare Zysten.

BACKGROUND: Free-floating intraocular cysts may be found in the anterior chamber (FZV) and the vitreous (FZG). The first description of a cyst was 150 years ago, and they are considered to be ocular rarities. MATERIALS AND METHODS: The actual knowledge about FZV and FZG is shown on the basis of two exemplary patients. RESULTS AND DISCUSSION: Patient 1 had a FZV as an incidental finding which had a smooth surface, a slight pigmentation and was translucent. The ultrasound biomicroscopy revealed an echo-free interior space. Without the patient's discomfort and missing treatment indication, a watch-and-wait strategy was chosen. Cysts of the iris can be classified as primary and secondary cysts. Primary cysts of the iris can arise from the stroma as the pigment epithelium wherein it is believed that FZV descend from the pigment epithelium. Secondary cysts and FZV can be generated by tumors, inflammation, epithelial ingrowth, the use of eye-drops or intraocular foreign bodies. Patient 2 showed marked myopic fundus changes and an FZG with a yellowish-greenish surface; the transparency was reduced and the surface was not pigmented. The ultrasound examination also revealed an echo-free interior space. Clinical controls were advised. Congenital and acquired causes are discussed for the formation of FZG. FZG could originate from the pigment epithelium of the iris, but there are conflicting study results. Trauma, inflammation and chorioretinal diseases are considered as a reason for acquired causes of FZG. The genesis, especially of FZG, is still unclear. For the treatment of patients with FZV and FZG, it is important to know the potential causes to be able to make a therapeutic decision. High quality photographic and sonographic documentation is needed in the watch-and-wait strategy.

Management of plateau iris syndrome with cataract extraction and endoscopic cyclophotocoagulation.

Plateau iris configuration describes an anatomic abnormality in which large or anteriorly positioned pars plicata push the iris root forward, thereby narrowing the anterior chamber angle. Plateau iris syndrome (PIS) is diagnosed if the angle remains occludable, either spontaneously or pharmacologically, after iridotomy. PIS has traditionally been treated with chronic pilocarpine or laser peripheral iridoplasty. A series of 9 eyes of 6 patients with PIS, diagnosed by dark room provocative testing and ultrasound biomicroscopy (UBM) following iridotomy, underwent cataract extraction and endoscopic cyclophotocoagulation (ECP). The ciliary body was treated for a median of 180° (range of 120-360°). Post-ECP, the angles in areas treated with ECP were open with corresponding flattened ciliary processes on UBM, while the angles remained occludable in quadrants untreated by ECP despite lens extraction. The mean follow-up time post-ECP was 73.7 ± 34 months (range 11-122 months). The mean IOP was reduced from a baseline of 25.2 ± 10.9 mm Hg on 3.4 ± 1.0 IOP lowering medications to a mean IOP of 17.1 ± 5.3 mm Hg (p < 0.05) on 1.9 ± 1.5, (p < 0.01) medications at last visit. There were no cases of chronic inflammation, eye pain, decreased vision, retinal detachment, or hypotony. Lens extraction and ECP offers an alternative treatment option for patients with PIS, which may directly address the underlying anatomic abnormality leading to angle closure in PIS.

Iris ultrastructure in patients with synechiae as revealed by in vivo laser scanning confocal microscopy : In vivo iris ultrastructure in patients with Synechiae by Laser Scanning Confocal Microscopy.

BACKGROUND: Iris plays important roles in ocular physiology and disease pathogenesis. Currently it is technically challenging to noninvasively examine the human iris ultrastructure in vivo. The purpose of the current study is to reveal human iris ultrastructure in patients with synechiae by using noninvasive in vivo laser scanning confocal microscopy (LSCM). METHODS: The ultrastructure of iris in thirty one patients, each with synechiae but transparent cornea, was examined by in vivo LSCM. RESULTS: Five characteristic iris ultrastructures was revealed in patients with synechiae by in vivo LSCM, which include: 1. tree trunk-like structure; 2. tree branch/bush-like structure; 3. Fruit-like structure; 4. Epithelioid-like structure; 5. deep structure. Pigment granules can be observed as a loose structure on the top of the arborization structure. In iris-associated diseases with Tyndall's Phenomenon and keratic precipitates, the pigment particles are more likely to fall off from the arborization structure. CONCLUSIONS: The ultrastructure of iris in patients with synechiae has been visualized using in vivo LSCM. Five iris ultrastructures can be clearly observed, with some of the structures maybe disease-associated. The fall-off of the pigment particles may cause the Tyndall's Phenomenon positive. In vivo LSCM provides a non-invasive approach to observe the human iris ultrastructure under certain eye disease conditions, which sets up a foundation to visualize certain iris-associated diseases in the future.

Pearl cyst treatment by surgical excision.

PURPOSE: Epithelial implantation cysts are rare complications of traumatic injury or incisional surgery resulting from transfer of surface epithelial cells from the cornea, conjunctiva, or periocular skin into the anterior chamber. They can either appear as solid, pearl white, or clear in the case of serous cysts. This study describes the clinical presentation, histopathological features, and surgical outcomes of a pearl cyst. CASE REPORT: A 19-year-old male subject first presented with corneal injury from a stone. After primary wound management, an eyelash was removed from the anterior chamber. The corneal wound was not sutured. Two months later, the patient was rehospitalized with a white mass in the anterior chamber. The mass was excised. Postoperative visual acuity was normal. Histological examination revealed an implantation cyst on the surface of the iris extensively covered with epithelial cells four to five layers thick in most areas. The patient has been followed up for 6 months without complications. CONCLUSIONS: The proliferation of traumatically implanted epithelial cells into the anterior chamber may lead to the development of a pearl cyst. The positive outcome in this case was consistent with the surgical treatment of choice evolving in the literature.

[A case of familial pupillary iris pigment epithelium cysts]. / Przypadek rodzinnego wystepowania zrenicznych cyst nablonka barwnikowego teczówki.

Iris cysts are rare lesions. In some cases, they may mimic melanoma and cause diagnostic difficulties. Through imaging tests such as ultrasound biomicroscopy we can evaluate the structure changes and determine the location for easy diagnosis. Iris cysts often require only observation. In some cases specialist treatment is necessary. One of the methods is transpupillary cystotomy perform using the Nd:YAG laser. The paper presents the case of familial pupillary cysts of the iris pigment epithelium in a father and a daughter.

Anterior segment swept-source optical coherence tomography and ultrasound biomicroscopy in iris and ciliary body lesions.

OBJECTIVES: Differentiation of iris and ciliary body lesions as benign or malignant and cystic or solid is important. The aim of this study was to compare anterior segment swept-source optical coherence tomography (AS SS-OCT) and ultrasound biomicroscopy (UBM) findings in iris and ciliary body tumors. RESEARCH DESIGN AND METHODS: Forty-two eyes of 38 cases with iris and ciliary body tumors imaged with UBM and AS SS-OCT between September 2018 and September 2023 were evaluated retrospectively. RESULTS: Of 42 eyes, 14 had melanoma, 14 iris pigment epithelial (IPE) cysts, 7 nevi, 3 Lisch nodules, 2 iris stromal cysts, 1 pars plana cysts, and 1 iris mammillations. An equivalent (100%) visualization of the anterior tumor margin was obtained with both techniques. Compared to AS SS-OCT, UBM was superior for posterior margin visualization in melanocytic tumors and IPE cysts. Bland-Altman plots demonstrated good agreement between UBM and AS SS-OCT for melanocytic tumors < 2.5 mm in base diameter and < 2 mm in thickness. CONCLUSIONS: Although, UBM is the gold standard for ciliary body and iridociliary tumors. AS SS-OCT should be considered as an excellent alternative to UBM, especially in minimally elevated iris lesions.

Treatment of peripheral pigment epithelium iris cyst with SLT laser.

PURPOSE: To report a case of a peripheral pigment epithelium iris cyst treated with selective laser trabeculoplasty laser. CASE REPORT: A 15-year-old girl applied to our clinic with the complaint of painless blurred vision in the right eye. Gonioscopy through a widely dilated pupil revealed a clear, oval, pale brown, semitransparent cyst that was located in the inferotemporal aspect of the iris. The cyst was touching the lens, and the lens was pushed superonasally by the cyst. The iris cyst was treated with selective laser trabeculoplasty laser. A small iris notch emerged at the 8-o'clock position of the pupillary margin. Only mild flare and minimal pigment dispersion were documented postoperatively, which resolved in a few days with a topical corticosteroid. CONCLUSIONS: Selective laser trabeculoplasty laser may be considered as a potentially useful and relatively less invasive technique in the treatment of peripheral pigment epithelium iris cysts.

Is preoperative ciliary body and iris anatomical configuration a predictor of malignant glaucoma development?

BACKGROUND: To investigate anatomical configuration of ciliary body and iris using ultrasound biomicroscopy as a predictor of malignant glaucoma development. DESIGN: Retrospective study in a tertiary care hospital. PARTICIPANTS: Cohort of 31 consecutive patients diagnosed with post-surgical malignant glaucoma. METHODS: Anterior chamber angle, iris and ciliary body configuration of involved eyes that had ultrasound biomicroscopy evaluation prior to the malignant glaucoma onset were evaluated. In cases with no presurgical ultrasound biomicroscopy exam of the involved eye, images from the fellow eye (imaged within 6 months) were analysed. MAIN OUTCOME MEASURES: Qualitative parameters. RESULTS: Thirty-one eyes (31 patients) had confirmed malignant glaucoma between 1996 and 2008. Most patients were women (65%) and had an anatomical narrow angle or angle-closure glaucoma (77%). Mean intraocular pressure at diagnosis was 30.4 ± 13.5 mmHg. The most common operation was trabeculectomy with mitomycin C (55%, 17/31 eyes), combined (3/17) or not (14/17) with cataract extraction and intraocular lens implantation. Among these 31 cases, we were able to evaluate the ultrasound biomicroscopy images of 13 patients (13 eyes) including involved eyes imaged prior to the malignant glaucoma onset or eligible fellow eyes. A narrow angle with or without iridotrabecular contact was found in all eyes. A large and/or anteriorly positioned ciliary body associated with an iris root angulating forward and centrally, revealing a plateau iris configuration, was noticed in 85% (11/13) of these eyes. CONCLUSION: Identification of plateau iris configuration by ultrasound biomicroscopy should be considered as a possible predictor of post-operative malignant glaucoma development.

[Analysis of anatomy features for patients with narrow anterior chamber angle and primary iridociliary body cysts].

OBJECTIVE: To investigate the prevalence and anatomy features of iridociliary body cysts in patients with narrow anterior chamber angle. METHODS: Retrospective case series study. The prevalence and anatomy features of iridociliary body cysts in 223 patients (402 eyes) were analyzed retrospectively with ultrasound biomicroscopy (UBM). All of the patients were examined for susceptive narrow anterior chamber angle without complaint. The age of the patients, the site, diameter and number of cysts, the anterior chamber angle and the central anterior chamber depth were measured. RESULTS: Iridociliary body cysts were found in 19 patients (23 eyes) out of 223 patients (402 eyes), the prevalence is 5.7%. Fifteen patients were unilateral and four patients bilateral. Two cases originated from the ciliary process, eighteen cases from the iris root, and three from both the root and posterior surface of the iris. Twenty one cases were single cysts while two cases were multiple cysts. The diameter of the cysts ranged from 0.5 to 3.1 mm, averaged (0.71 ± 0.53) mm. The average age and the central anterior chamber depth of the eyes with iridociliary body cysts were (55.32 ± 10.74) years and (2.25 ± 0.39) mm, with no significant difference (t = 0.534, 0.783; P > 0.05) as compared to that of patients without cysts, which were (57.46 ± 10.52) years and (2.14 ± 0.34) mm. The anterior chamber angle in iridociliary body cysts group was 8.2° (21.0°, 0.0°), with no significant difference (Z = -0.062, P > 0.05) as compared to that of patients without cysts, which was 8.9° (21.4°, 0.0°). CONCLUSIONS: The prevalence rate of iridociliary body cysts in this study is 5.7%, central anterior chamber depth and anterior chamber angle in patients with cysts do not differ form patients without cysts.

Comparing the Effect of Lens Extraction With Endocycloplasty to Lens Extraction Alone in Eyes With Plateau Iris Configuration: Pilot Study.

PRECIS: Lens extraction with endocycloplasty (LE/ECPL) results in greater angle deepening than LE alone in plateau iris eyes. This study directly compares an LE/ECPL treatment group with a control group. PURPOSE: Quantitatively determine the effect of LE/ECPL versus LE alone for eyes with plateau iris configuration/plateau iris syndrome (PIC/PIS) on angle parameters. METHODS: Patients with PIC/PIS who underwent LE/ECPL or LE alone were reviewed. Eyes with ultrasound biomicroscopy-documented PIC that underwent anterior segment optical coherence tomography examination before and after treatment were included. Angle parameters, angle opening distance (AOD), trabecular-iris space area (TISA), and trabecular-iris circumference volume (TICV) were calculated. Angle parameters were compared between treatments using a 2-sample t test. P-values were adjusted by the false discovery rate method (P*). A paired t test was used to compare treated (nasal) and untreated (temporal) angles in LE/ECPL-treated eyes. RESULTS: Twenty-three eyes of 14 participants were included. Ten eyes (43%) eyes of 7 participants were treated with LE/ECPL, and 13 eyes (57%) of 7 participants were treated with LE alone. Angles were deepened in both groups (P<0.001). Changes in AOD, TISA, and TICV showed that the magnitude of deepening in treated (nasal) quadrants was greater in LE/ECPL eyes than in LE alone eyes (P<0.05). ECPL-treated angles deepened more than the untreated angles by AOD, TISA, and TICV (P<0.002). CONCLUSION: Our study suggests that LE/ECPL is more effective than LE alone in opening the anterior chamber angle and that ECPL deepens treated angles more than untreated angles. This study directly compares an LE/ECPL treatment group with a control group, LE alone, allowing for separation of the effect of ECPL from LE.

A Case of Annular Iris Cyst Diagnosed With the Help of Ultrasound Biomicroscopy.

PURPOSE: To report a case of annular iris cyst presenting as a secondary angle closure managed with Nd:YAG laser iridotomy. DESIGN: Case report. METHODS: Institutional review board exemption for this case report was obtained from the institutional ethics committee, Aravind eye hospital, Tirunelveli. All research adhered to the tenets of the Declaration of Helsinki. Informed consent was obtained.A 45-year-old woman presented with a 2-week history of sudden onset of pain and redness in the right eye. Slit-lamp biomicroscopy showed corneal edema, with the shallow anterior chamber, convex bowing of iris, irregular shape of the pupil, and glaucomflecken on the clear lens. Ultrasound biomicroscopy revealed an annular iris cyst of the iris pigment epithelium. Nd:YAG laser iridotomy was done to drain the cyst and relieve the angle closure. RESULTS: Laser treatment resulted in the collapse of the cyst, confirmed by ultrasound biomicroscopy and disappearance of the subject symptoms. CONCLUSION: Iris cysts are usually benign in nature. An annular iris cyst is a rare presentation. They can present with a secondary angle closure as in our report. Correct diagnosis and timely intervention bring about a desirable result. With this report, the authors aim to catalog and familiarize ophthalmologists with a rare ocular pathology and its management.

Using Anterior Segment Optical Coherence Tomography (ASOCT) Parameters to Determine Pupillary Block Versus Plateau Iris Configuration.

PRéCIS:: The potential parameters for differentiating pupillary block (PB) from plateau iris configuration (PIC) on anterior segment optical coherence tomography (ASOCT) are lens/pupil size parameters and angles. Further study is needed to determine a landmark peripheral to the centroid of the iris. PURPOSE: Investigate anterior segment parameters to distinguish between 2 mechanisms of angle closure, PB and PIC, using swept-source Fourier domain ASOCT. PATIENTS AND METHODS: Retrospective ASOCT images from narrow angle eyes were reviewed. PIC was defined either by ultrasound biomicroscopy and/or clinically when an iridoplasty was performed. Images were read by a masked reader using Anterior Chamber Analysis and Interpretation software to identify scleral spur landmarks and calculate anterior chamber, peripheral angle, iris size, iris shape, and lens/pupil size parameters. ASOCT parameters were summarized and compared using the 2-sample t test. Thresholds and area under receiver operating characteristic curve were calculated using logistic regression analysis. RESULTS: One hundred eyes (66 PB and 34 PIC) of 100 participants were reviewed. Of all ASOCT parameters, iris length in each quadrant, pupil arc, lens/pupil parameters (pupil arc, lens vault, and pupil diameter), all pupillary margin-center point-scleral spur landmark (PM-C-SSL) parameters, and all except superior central iris vault parameters were significantly different between PB and PIC. On threshold evaluation, lens/pupil parameters had the greatest area under receiver operating characteristic curve values (0.77 to 0.80), followed by PM-C-SSL angles (0.71 to 0.75). CONCLUSIONS: We propose that the pupil size parameters and PM-C-SSL angle are the most reliable novel ASOCT parameters to distinguish between PB and PIC eyes. These parameters do not rely on the visibility of the posterior iris surface, which is difficult to identify with ASOCT, but may be ambient lighting dependent.

Clinical, Demographic, and Tomographic Aspects Related to Iris Mammillations Among Patients With Keratoconus: A Cross-Sectional Study.

PURPOSE: Iris mammillations (IM) were previously described in patients with keratoconus, but the clinical implications of this finding have never been studied. Our aim was to investigate demographic, tomographic, and clinical characteristics potentially associated with the presence of IM among patients with keratoconus. METHODS: This was a cross-sectional study performed among patients with keratoconus in a public-affiliated university hospital. All patients under follow-up were considered eligible to participate in the study. Participants were evaluated by 2 trained ophthalmologists and submitted to corneal tomography (Pentacam). Selected demographic, clinical, and tomographic characteristics were assessed and compared among participants with IM (IM group) and without IM (No-IM group) using the Wilcoxon test or 2-tailed Fisher exact test, as appropriate. RESULTS: The study population consisted of 106 subjects and 19 (17.9%) presented with IM. The median age and interquartile range were 18 years old (14-24) in the IM group and 20 years old (17-24) in the No-IM group (P = 0.135). The female proportion was 47.3% in the IM group and 52.8% in the No-IM group (P = 0.801). Median (interquartile ranges) pachymetric values of the right eyes were 498 (466-525) for the IM group and 459 (421-482) for the No-IM group (P = 0.005). For the left eyes, the values were 490 (456-523) in the IM group and 450 (418-485) in the No-IM group (P = 0.024). CONCLUSIONS: Subjects with keratoconus presenting with IM have thicker corneas than those without IM. Follow-up studies should be performed to evaluate the clinical implications of this finding.