Cysts and tumours of the iris: Diagnostic tools and key management considerations-A review.

The iris is a unique structure, with exquisite variations in colour and form. Pathological changes, specifically including iris cysts and tumours are relatively uncommon, difficult to diagnose, and yet potentially blinding or life-threatening. Based on a comprehensive literature review, with highly illustrated key case examples, this report aims to guide the clinician in filtering the differential diagnoses of iris cysts and tumours. Evaluation is in the context of key diagnostic clinical tools and management considerations. Diagnostic imaging techniques include serial anterior segment photography, ultrasound, anterior segment optical coherence tomography, and iris fluorescein angiography, however, the roles of computerised topography and magnetic resonance imaging are also considered in this review. Management includes categorisation in terms of solid iris tumours (melanocytic vs. non-melanocytic), or iris cysts (primary vs. secondary) that may be usefully differentiated by clinical assessment, avoiding more invasive interventions. Cystic lesions are generally benign, although implantation cysts in particular cause significant complications and surgical challenges. Most solid tumours are melanocytic and also typically benign. However, in larger lesions, rapid growth, symptoms and complications more likely indicate malignancy, requiring further investigation.

Iris cyst after femtosecond laser-assisted cataract surgery: a case report.

BACKGROUND: Secondary iris cysts are uncommon complication after cataract surgery. The reports of an iris cyst after conventional phacoemulsification surgery are scanty, let alone the iris cyst following femtosecond laser-assisted cataract surgery (FLACS). We herein report an unusual case of an iris cyst after an uneventful FLACS. CASE PRESENTATION: A 64-year-old man who was healthy underwent FLACS for a moderate cataract of his left eye. Shortly after surgery, he achieved 20/20 vision, but anterior bowing of temporal iris was noted on postoperative day 9 with a retro-pupillary iris cyst at temporal-inferior quadrant found after pupil dilatation. The cyst was confirmed by ultrasound bio-microscopy afterward. Four weeks later, argon laser cystotomy was performed, and the cyst disappeared 3 days later. The patient's vision remained stable thereafter. CONCLUSION: Although rare, secondary iris cyst may be one of the complications after FLACS. Argon laser cystotomy is effective in the management of post-FLACS iris cyst.

[Laser treatment of giant iris cyst in the anterior chamber in a child (a clinical observation)]. / Lazernoe lechenie gigantskoi kisty raduzhki i perednei kamery u rebenka (klinicheskoe nabliudenie).

The article describes a clinical case of a giant post-traumatic iris cyst occupying the anterior chamber in a 3-year-old child successfully treated with laser methods (YAG-laser and diode-pumped laser with doubled frequency). Cyst scarring was achieved with preservation of visual acuity of 1.0. The follow-up period lasted 10 years. The question of indications for laser methods of eliminating cysts of the anterior segment of the eye in children remains debatable. The huge size is traditionally considered a contraindication for laser treatment of the cyst; it leads to death of the organ more often, especially after radical surgical removal of the cyst. The described case confirms the feasibility of non-invasive laser treatment efforts even if the cyst is huge in size.

Transcorneal aspiration for management of primary iris cysts in the standing horse.

BACKGROUND: Equine primary iris cysts are usually incidental findings but, if associated with clinical signs, may require intervention. The use of laser (Nd:Yag or diode) has been reported but requires specialised equipment. Transcorneal aspiration has not been previously evaluated in the standing horse. OBJECTIVES: To review outcomes of standing transcorneal aspiration of primary iris cysts (STAPIC) in horses. METHODS: Horses were identified from electronic patient records from 2018 to 2024 across four collaborating centres. Clinical presentation and outcomes were identified and reported using descriptive statistics. RESULTS: Eighteen horses were identified. Behavioural signs reported included 'spooking' and changes in rideability often associated with jumping. Single large unilateral cysts were present in 11 horses, bilateral cysts in three horses and multiple unilateral cysts in four horses. Following treatment, one horse developed uveitis and fibrin in the anterior chamber associated with needle contact with the iris stroma due to movement, and a second horse developed fibrin within the anterior chamber. Both conditions resolved with anti-inflammatory medication and administration of tissue plasminogen activator. No other adverse effects were reported. Follow-up was available from all horses (median: 6 months, interquartile range [IQR]: 4-11 months) with no recurrence, although one horse developed an iris cyst in the contralateral eye after 3 years. All owners reported improvement in clinical signs, with 61% reporting no further signs. CONCLUSIONS: STAPIC is an effective and easily accessible alternative for treating iris cysts in horses rarely associated with complications.

Surgical Proposition of a Slow-Growing Calvarial Exostosis in a Female Patient With a Congenital Iris Cyst of the Anterior Chamber and Mandibular Tori.

We present an unusual case of a woman in her early 50s with a slow-growing calvarial exostosis. Exostoses are bony spurs or osteomas extending outward beyond a bone's surface and may be benign or malignant. Calvarial exostoses are a less common bone tumor that can occur in the population. We present a case of a rare, slow-growing calvarial exostosis with a combination of mandibular tori and a congenital iris cyst. We discuss differentials of this exostosis and different syndromes that may cause it such as hereditary multiple exostoses and Gardner syndrome. The current article aims to spread awareness of this atypical presentation of exostoses and present our institution's surgical proposition for removing a calvarial exostosis to obtain a further histological analysis of its composition. As these masses may commonly be benign, a definitive diagnosis cannot be made through imaging alone to rule out more threatening conditions. We have addressed radiological findings and diagnostic and treatment options offered to the patient. The patient decided not to move forward with removing the mass and would continue to monitor and return should she notice any unusual or acute changes.

Surgical management of post-traumatic iris cyst: A case report.

INTRODUCTION AND IMPORTANCE: Cysts of the iridociliary complex could be primary or secondary. Small and asymptomatic iris cysts can be monitored, whereas larger cysts require treatment as they can cause severe complications. Treatment modalities can range from minimally invasive techniques to aggressive surgical procedures. CASE PRESENTATION: We report the case of an 11-year-old child who applied to our department with blurred vision. The anterior segment examination of the right eye revealed an oval, light brown, semi translucid cyst, located in the iris extending to corneal endothelium. The iris cyst was managed surgically. A pigment magma on the anterior surface of the lens was observed and was respected in order not to induce a cataract. Surgical treatment consisted of total removal of the external cyst layer. CLINICAL DISCUSSION: There are numerous different methods for treating iris cysts. The main goal of treatment is to be as little intrusive as possible. Cysts that are small, stable, and asymptomatic can be observed. To avoid major issues, larger cysts may need to be treated. When less intrusive treatments have failed, surgery is always the final option. In our case, the post-traumatic iris cyst was immediately treated surgically by aspiration followed by excision of its wall, because of the significant visual disturbance, the age of the patient, and the corneal endothelial touch. CONCLUSION: Surgical intervention remains the last option, especially when less invasive options did not reveal to be successful due to the extensive nature of the lesion.

Symptomatic familial primary iris cysts at the pupillary margin in three consecutive generations: A case series.

Case series purpose: Iris 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. Observations: The 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 Importance: IPE 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.

Intraoperative optical coherence tomography guided iris stromal cyst treatment with absolute alcohol injection.

Purpose: To report on the utility of intraoperative optical coherence tomography (iOCT) in the treatment of a traumatic iris cyst with aspiration and alcohol injection. Observations: A 61-year-old male, with a past ocular history of a left corneoscleral laceration in 1982, presented with gradual onset of blurring of vision in 2021. Examination revealed a large iris stromal cyst. He subsequently underwent iOCT guided iris stromal cyst aspiration and absolute alcohol injection. Conclusions and importance: Our case demonstrated the efficacy of iOCT to aid in direct visualization and safe guidance of the alcohol into the iris cyst, reducing the risk of collateral damage.

Tissue glue for management of large iris cyst.

Purpose: To present a novel technique utilizing fibrin glue-assisted adhesion as adjuvant to fine needle aspiration for management of post-surgical peripheral iris stromal cyst. Observations: A 61 year-old male presented with a 4.20 × 7.56 × 8.22 mm well-circumscribed, fluid-filled peripheral cystic lesion involving the central visual axis with local posterior displacement of the intraocular lens. Surgical drainage was performed with the adjuvant use of fibrin glue to enhance the annealing of cyst walls. The patient tolerated the procedure without significant complications. At final post-operative visit, vision improved to 20/30 and there was no recurrence of the cyst. Conclusions and importance: To our knowledge, this is the first report describing the use of fibrin glue to successfully treat a post-surgical peripheral iris stromal cyst. Fibrin glue may serve as an effective alternative to ethanol and sclerosing agents in the management of iris cysts.

Keratin pearl cyst formation after traumatic implantation of an eyelash into the anterior chamber: A case report.

Purpose: We introduce a case with creamy white pearl-like keratin cysts in the anterior chamber after a penetrating injury associated with eyelash implantation. Observations: A 5-year-old girl presented with a history of penetrating corneal injury with a knife ten months ago. An eyelash was removed from the anterior chamber during her previous primary repair. Her parents complained about the presence of a white mass in her repaired eye, which had appeared about nine months after surgery. After the visco-expression of these solid masses, the histopathological evaluation revealed keratinous material surrounded by multinucleated giant cells. Conclusions and importance: In a case of post-traumatic implantation of eyelash into the anterior chamber, despite removing the cilia, cysts may develop, which suggests proliferating epithelial cells embedded within the anterior chamber.

DMEK with endophotocoagulation and cyst wall removal for corneal endothelial decompensation due to iris cyst.

PURPOSE: Iris cysts may arise secondary to surgical or nonsurgical trauma, potentially leading to corneal decompensation via mechanical injury to the adjacent endothelium. However, no well-established protocol exists for the treatment for corneal edema arising therefrom. OBSERVATIONS: A 58-year-old white male presented with an iris mass of his left eye; it occupied 1/3rd the anterior chamber volume and directly contacted the corneal endothelium. The cornea was diffusely edematous, and best corrected visual acuity (BCVA) measured 20/70 (0.3). Corneal endothelial decompensation secondary to iris cyst was diagnosed. Treatment consisted of endophotocoagulation and vitrectomy probe removal of the cyst wall, with Descemet membrane endothelial keratoplasty (DMEK) also performed as a single, combined procedure. The patient subsequently experienced a resolution of his corneal edema and disappearance of his iris cyst, without recurrence of either condition. BCVA improved to 20/25 (0.8). CONCLUSIONS AND IMPORTANCE: Iris cyst may be a rare cause of corneal decompensation. Viable treatment may entail a single-stage procedure involving endophotocoagulation and vitrectomy probe application to the cyst wall combined with DMEK.

Implantation iris cysts developing 24 years after penetrating keratoplasty.

PURPOSE: To report a case of iris implantation cysts occurring 24 years after penetrating keratoplasty and its management. OBSERVATIONS: A 60-year-old man was referred for diagnosis and management of white iris masses of the right eye. He had undergone bilateral penetrating keratoplasty 24 years before without complication. The clinical findings were suggestive of iris implantation cysts and Ultrasound Biomicroscopy (UBM) and anterior-segment optical coherence tomography confirmed the diagnosis. The patient did not develop any ocular complications from the cysts after one-year follow-up from the diagnosis of iris implantation cysts. CONCLUSIONS AND IMPORTANCE: Iris implantation cysts are rare benign tumors that develop after the ectopic implantation of epithelial cells within the iris stroma. They can be congenital or secondary to penetrating trauma or surgery. Their diagnosis relies on clinical examination and UBM. In case of intraocular complications, treatment may be required, otherwise observational follow-up is appropriate.

Optical Coherence Tomography and ImageJ Software for objective assessment of optical density of anterior chamber iris cyst.

Aim: To report the optical characteristics of the fluid in an anterior chamber iris cyst. Method: A 26-year-old male presented with blurring of vision in his right eye for two months, without any other associated ocular complaints. His visual acuity was 6/ 9 on Snellen's chart. On slit lamp examination, a small translucent pigmented cyst was noted inferiorly in the anterior chamber, struck on to the cornea at 6 o'clock periphery, without any feeder vessel. Anterior segment optical coherence tomography (OCT) revealed a cystic lesion with hyperreflective walls and hypo reflective lumen attached to the cornea, compressing the endothelium. Results: The optical density (OD) of the cyst fluid was determined using ImageJ, an open code Java-based image processing software. The OD of cyst fluid was found comparable to the anterior chamber fluid. Conclusion: Ultrasound biomicroscopy (UBM) and OCT are useful tools for the diagnosis of cystic lesions of the anterior segment. The innovative use of an OCT image and the ImageJ software to determine the optical density of the iris cyst may aid in the diagnosis and follow-up of such cases.

A secondary iris cyst with 3 years of asymptomatic period following a blunt ocular trauma.

PURPOSE: To present a relatively uncommon case with a secondary iris cyst in the anterior chamber and its successful management with an anterior chamber mass excision surgery. CASE REPORT: A 46-year-old Chinese woman presented with a dark shadow in her left eye for 6 months without any other discomfort. She had a history of blunt ocular trauma by a badminton strike 3 years ago. Slit-lamp examination showed a small, nearly circular, sharply demarcated, and movable mass in the anterior chamber OS, which could change its position with head tilt. The anterior segment optical coherence tomography revealed a well-circumscribed cystic lesion in the anterior chamber with higher reflective outer layer and lower internal reflectivity. An anterior chamber mass removal surgery was performed without recurrence up to 1 year. CONCLUSION: Secondary free-floating iris cyst following a blunt trauma is rarely reported. It is relatively stable and nonprogressive so it may remain asymptomatic for a long time. Appropriate imaging techniques are necessary for facilitating diagnosis and therapy. Therapeutic management should be considered if visual symptoms arise, especially when complications occur.

Iris cysts: Varied presentations and review of literature.

An iris cyst is a nonkeratinized squamous epithelial-lined space involving a layer of iris. The presentation of iris cyst can be variable-innocuous or presenting with secondary complications. The identification of whether the cyst is primary or secondary is important. The prognosis of primary iris cysts is good, as the majority does not require treatment and that of secondary iris cysts is much more capricious depending on their presentation. Their optimal management often poses a challenge for ophthalmologists. Here, we will present two cases of iris cysts with diverse presentation along with a review of the literature of this rare clinical entity.

Management of an iris stromal cyst by fine needle aspiration with absolute alcohol irrigation and argon laser photocoagulation to induce sclerosis.

PURPOSE: To describe the management of an iris stromal cyst by fine needle aspiration and irrigation with absolute alcohol to induce cyst sclerosis. METHODS: We present the case of a 45-year-old patient with no previous history referred for a 3-month history of an iris lesion in his right eye. Examination revealed a 2.1×3mm cyst with transparent walls at the right inferonasal iris root, and a primary acquired iris stromal cyst was diagnosed. Initially, observation was recommended, but at the 2-month follow-up, growth of the lesion was observed, so fine needle aspiration and cryotherapy were performed, with recurrence after 2 months. Subsequently, fine needle aspiration and irrigation with absolute alcohol for 2minutes to induce sclerosis of the cyst was carried out. Two weeks after surgery, argon laser was performed on the iris root and remaining walls of the cyst to induce adherence. RESULTS: After 1 year of the procedure, the patient remains asymptomatic, without associated complications. A depression and hyperpigmentation of the iris in the inferonasal sector persists, without recurrence of internal fluid or increase in cyst volume. Endothelial cell count and intraocular pressure monitoring have remained stable. CONCLUSION: Iris stromal cyst sclerosis by aspiration and irrigation with absolute alcohol was effective and avoided complications associated with resection of the lesion.

Iris and ciliary body cysts and phakic intraocular lenses.

Phakic intraocular lenses are used to correct refractive errors. The procedure is predictable and potentially reversible. The procedure is not free of complications though. The occurrence of iris cyst after implantation of a phakic intraocular lens was not described previously in the literature. We describe two cases of iris cysts in the presence of a phakic intraocular lens; the first case describes a cyst which was not present prior to the anterior chamber phakic intraocular lens implantation. The second case describes a hidden iris cyst that affected the posterior chamber phakic intraocular lens position and lead to glaucoma.

A Case of a Cavitary Iris Melanoma with Aqueous Cytological Modulation.

Malignant melanoma is the most common primary malignant tumour of the iris, but represents a small proportion of all uveal melanomas. The authors describe a 34-year-old male with a pigmented lesion of the iris. The lesion remained stable for 7 years, but the patient re-presented after this time with sudden enlargement of the mass and hyphaema. Excisional biopsy confirmed cavitary melanoma of the iris. This is the first reported case of cavitation in a primary iris melanoma. The patient has not had any further adjuvant treatment and remains metastasis free at 5 years of follow-up.

[Clinico-echographic diagnostics of iris tumors]. / Klinisch-echographische Diagnostik bei Iristumoren.

BACKGROUND: The differentiation of iridic space-occupying lesions represents a regularly reoccurring diagnostic challenge. OBJECTIVE: This article presents an overview of the epidemiological data and describes the diagnostic procedure for iris tumors. MATERIAL AND METHODS: The article provides a review of the literature from PubMed and own clinical results. RESULTS: Melanocytic lesions comprise the vast majority of all iris tumors and include nevi and melanomas. Slit lamp biomicroscopy with standardized photography reveals two-dimensional planar tumor growth over time, which is the only recognized clinical surrogate finding for a malignant event. Ultrasound biomicroscopy (UBM) is additionally obligatory because it is the only method which enables documentation of the extent of tumor penetration, ciliary body involvement and internal structure of iris tumors. CONCLUSION: Serial slit lamp and UBM examinations with reproducible pupillary diameters are indispensable for the differentiation of cystic, solid and tumor-simulating lesions and for the detection of malignant transformation in iris tumors.