Inadvertent rupture of iridociliary cyst following transscleral Diode laser

Abstract

Primary iridociliary cysts can induce plateau iris configuration and angle closure glaucoma. We report a patient with bilateral, primary, ring-shaped, solitary iridociliary cysts. The right eye displayed normal intraocular pressure, oppositional iridocorneal angle closure, and healthy optic nerve head. The left eye had advanced chronic angle closure glaucoma. The management strategy varied between eyes and is discussed. This, to the best of our knowledge, is the first report of transscleral Diode laser application in an eye with a large iridociliary cyst.

Phaco-endocycloplasty: A novel technique for management of ring iridociliary cyst presenting as acute angle closure

“…In addition, in view of 360° synechial angle closure, collapse of cyst (cystotomy) too was not considered an option as control of IOP could potentially become a serious issue, in addition to possible inflammation, as encountered by Choudhari et al . [ 4 ] In our patient, direct visualization and ECPL achieved dual purpose – it helped us avoid rupture of cyst, potentially avoiding severe inflammation, and reduced aqueous production as evidenced by adequately controlled-IOP without medication; cataract extraction helped in visual rehabilitation.…”

“…[ 3 ] reported appositional angle closure due to ring cyst, visible at the slit lamp, that resolved on argon laser rupture of the cyst (pigment epithelial iridotomy) while transscleral diode photocoagulation (TSCPC) was used by Choudhari et al . [ 4 ] in synechial angle closure which failed to control IOP; incidentally, latter also reported resolution in appositional angle closure due to ring cyst with YAG iridotomy alone, in fellow eye. Kuchenbecker et al .…”

“…Rupture of the cyst can be fraught with complications, and severe protracted inflammation has been encountered in the past, when accidental rupture of cyst has occurred, following TSCPC. [ 4 ]…”

“…[ 1 ] Often they are solitary, but multiple cysts with pseudo-plateau appearance have also been reported. [ 2 ] Ring iridociliary cysts are rarer still and only one case of unilateral[ 3 ] and two cases of bilateral,[ 4 5 ] ring iridociliary cyst presenting with raised intraocular pressure (IOP) and closed angles have been reported in the literature.…”

Elevation of intraocular pressure due to ciliary body and iris cysts ”pseudoplateau iris” – case report

“…However, the vast majority have a mild course and do not require treatment [1,2,5,6,8,9]. By displacing the iris, they can cause "pseudoplateau iris" (PPI) either with or without filtration angle closure [3,4,10,11]. For the diagnosis of PPI, visualization of cysts at the iridociliary sulcus is necessary.…”