Spontaneous Regression Of A Primary Iris Stromal Cyst In A Patient With Keratoconus. A Case Report
Galvis, V., Shields, Tello, A., Niño, Laiton, García, Chaparro, & Viteri (2021). SPONTANEOUS REGRESSION OF A PRIMARY IRIS STROMAL CYST IN A PATIENT WITH KERATOCONUS. A CASE REPORT. SPONTANEOUS REGRESSION OF A PRIMARY IRIS STROMAL CYST IN A PATIENT WITH KERATOCONUS. A CASE REPORT. Ceska a slovenska oftalmologie : casopis Ceske oftalmologicke spolecnosti a Slovenske oftalmologicke spolecnosti, 77(5), 253–256. https://doi.org/10.31348/2021/28
View Original Source →Abstract
PURPOSE: To report the rare case of a 29-year-old male with a history of keratoconus, who presented with a primary iris stromal cyst which eventually showed spontaneous regression. METHODS: Description of the clinical findings in the case of a 29-year-old male with a prior history of keratoconus, but no eye surgery or trauma, who consulted for an iris cyst in the left eye, diagnosed 9 months earlier. CASE REPORT: Slit-lamp examination revealed mild dyscoria, and a large cyst in the inferior quadrant of the iris. Ultrasound biomicroscopy and anterior segment optical coherence tomography of the left eye confirmed the presence of a giant iris cyst with thin walls, in contact with the corneal endothelium. Corneal endothelial cell density in the inferior cornea (close to the cyst) was 1805 cells/mm2 and 2066 cells/mm2 in the central area. After considering the risk of anterior chamber epithelial downgrowth following any surgical procedure of the cyst, the patient received conservative management. In the following months, the patient presented with 3 episodes of anterior uveitis, managed with topical corticosteroids. Finally, at approx. 21 months after the initial diagnosis, the cyst presented spontaneous regression. Anterior segment optical coherence tomography confirmed the absence of fluid inside the cyst remnants and the final endothelial cell densities evidenced endothelial cell loss (inferior cornea 738 cells/mm2 and central cornea 1605 cells/mm2). CONCLUSION: Conservative management should be considered in patients with cysts that show slow progression and are distant from the visual axis, in order to minimise the risk of complications following any surgical procedure of the cyst. In addition, the present case is one of the few of primary stromal iris cysts with spontaneous regression reported in the literature.
Case Details
Disease Location
Eye
Personal Characteristics
29-year-old male. History of keratoconus, and the usage of rigid contact lenses
Clinical Characteristics
Reported that about 9 months before the initial examination, he was diagnosed with an iris cyst in his left eye. A clear cornea, mild dyscoria, and a large cyst on the inferior quadrant of the iris (from the 5 to 7 o’clock position), rather translucent, partially divided into 2 cavities, with few accumulations of pigment on its smooth surface, were found in the left eye. Anterior segment optical coherence tomography (as-oct) of the left eye showed a large cyst composed of two communicated cavities, protruding from the anterior surface of the iris, and making contact with the corneal endothelium. One month later, the patient consulted us, complaining of 3 days of pain in the left eye and perilimbal inferior redness. Eye redness and anterior chamber cellularity +++ were evidenced. Hence, anterior uveitis was diagnosed, probably secondary to microrupture of the cyst, and he received management with 1% topical prednisolone. Two weeks later, the inflammation finally resolved. During the next 9 months, the patient presented with two additional episodes of anterior uveitis, which were also managed with topical corticosteroids.
Remission Characteristics
21 months after the initial diagnosis of the primary iris stromal cyst, the patient reported that he had not had symptoms for about 3 months. Slit-lamp biomicroscopy of the left eye revealed a clear cornea, mild dyscoria, and subtotal regression of the cyst. The as-oct confirmed the absence of fluid inside the cyst remnants.