Transpupillary Nd:YAG Laser Cystotomy for Iris Pigment Epithelial Cysts with Secondary Progressive Angle Closure

Abstract

Two patients were diagnosed as having unilateral iris pigment epithelial (IPE) cysts that were documented to enlarge and induce angle closure. Transpupillary IPE cystotomies were performed using the Nd:YAG laser as a prophylactic measure to prevent angle-closure glaucoma. Anterior chamber anatomy and cyst dimensions were assessed before, during, and after long-term follow-up using slit-lamp biomicroscopy, gonioscopy, and 20- or 35-MHz high-frequency ultrasound imaging. Cystotomy resulted in immediate, visible deflation of both IPE cysts with subsequent resolution of angle closure. The cyst contents appeared clear and no secondary inflammation or glaucoma occurred. No evidence of cyst recurrence has been noted during 3 and 8 years of follow-up, respectively. Transpupillary Nd:YAG laser cystotomy offered a minimally invasive and effective treatment for angle closure induced by progressive IPE cysts.

A Case of an Iris Cyst Not to Be Missed

“…3 When visual compromise does occur, these cysts can be treated with argon laser photocoagulation, fineneedle aspiration with cryotherapy, surgical resection, or Nd:YAG laser cystotomy. 7,8 The goal of treatment is to be as minimally invasive as possible. Fine-needle aspiration alone results in high rates of recurrence.…”

“…They can occur circumferentially around the pupillary margin, rarely cause any visual disturbance, and often require no intervention . When visual compromise does occur, these cysts can be treated with argon laser photocoagulation, fine-needle aspiration with cryotherapy, surgical resection, or Nd:YAG laser cystotomy . The goal of treatment is to be as minimally invasive as possible.…”

Combined Laser Treatment in a Patient With Pigment Dispersion Secondary to a Large Iris Pigment Epithelial Cyst

“…Although they rarely have clinical significance, there may be some cases having significant angle compromise and must be treated as required for glaucoma (1)(2)(3)(4)(5). In some case reports, they were defined as a result of some medications or surgical procedures (6,7).…”

Surgical Cystotomy of a Large Iris Pigment Epithelial Cyst with Microinstrumentation

“…Current management options include needle aspiration with or without adjunctive cryotherapy [4, 5], laser photocoagulation or cystotomy [3, 6], and en bloc surgical resection [5]. We present a surgical technique to collapse an iris pigment epithelial cyst using microsurgical instruments introduced via paracentesis.…”