Free-Floating, Pigmented Cysts in the Anterior Chamber Causing Ocular Hypertension

Abstract

Purpose: The aim of this study was to describe the clinical and histopathological features of a 36-year-old male with hundreds of recurrent, unilateral, free-floating, pigmented cysts in the anterior chamber causing ocular hypertension. Procedures: The patient was referred to ocular oncology for blurry vision of the right eye and was found to have myriad pigmented, free-floating cysts in the anterior chamber and heavy pigmentation of the angle on gonioscopy. Anterior chamber washout was performed, and the fluid recovered was sent for pathological analysis. Results: The pathology report demonstrated rare nonpigmented epithelial cells, more consistent with iris stromal cysts or secondary implantation epithelial cysts. Conclusions: This paper highlights the first documented case of innumerable spontaneously occurring, unilateral, free-floating, pigmented cysts in the anterior chamber. While clinical diagnosis suggested iris pigment epithelial cysts, pathology suggested iris stromal cysts or secondary implantation epithelial cysts.

Atypical free‐floating iridociliary pigmented epithelial cysts and secondary glaucoma in a caiman (Caiman latirostris)

“…However, the traumatic process may also have been a trigger for glaucoma 3 . The left eye of our patient suffered from secondary glaucoma due to iridocorneal angle closure by the numerous cysts, epithelial cords and collagen 16,19 . These findings are similar to those reported by Deehr and Dubielzig 5 who performed a histopathological evaluation of iridociliary cysts and glaucoma in 13 Golden Retriever dogs and hypothesized that the obstruction of the iridocorneal angle by the iridociliary cysts may prevent the flow of aqueous humor from the posterior to the anterior chamber, causing secondary glaucoma.…”

“…Cysts arising from the posterior epithelial layers of the iris tend to be clinically diagnosed as malignant melanomas of the ciliary body and iris 5,7,16 . The differential diagnosis for iridociliary epithelial cysts include iris melanoma, ciliary body melanoma, and other rare tumors such as leiomyoma, meduloepithelioma, and melanocytoma 7 .…”

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“…Complications that arise typically are mechanical in nature and associated with cyst growth, such as pigment dispersion syndrome, [7] plateau iris, and angle closure glaucoma before dislodging, recurrent iritis, and direct angle obstruction from multiple small cysts. [8] Other types of iris cysts can directly obstruct the visual axis and require intervention, including those that are large and originate from the iris pupillary margin such as iris flocculi or giant midzonal/ peripheral IPE cysts.…”