The Diagnostic and Therapeutic Challenges of Posttraumatic Iris Implantation Cysts: Illustrative Case Presentations and a Review of the Literature

Abstract

Posttraumatic iris implantation cysts are rare ocular findings that are often associated with poor visual outcomes. Iris implantation cysts can present clinicians with diagnostic and therapeutic challenges given their variable presentations and frequently destructive nature. In this paper, we provide descriptions of two unusual cases of posttraumatic iris implantation cysts. The first case is of a recurrent keratin-filled iris implantation cyst that developed after open globe injury and intraocular implantation of cilia and was treated with cyst debulking procedures, injections of 5-Fluorouracil, and iridocyclectomy. The second case is of recurrent posttraumatic serous iris implantation cysts that were treated with laser, cyst aspiration, and injections of 5-Fluorouracil. We use these cases as a platform to discuss the different manifestations of implantation cysts, the roles of anterior segment optical coherence tomography, ultrasound biomicroscopy, and histopathology in facilitating timely and accurate diagnosis and review the range of available therapeutic modalities. We discuss conservative treatment approaches, including the novel use of 5-Fluorouracil therapy as an adjunct therapy, as well as more aggressive surgical excision requiring ocular reconstruction. Through a discussion of these cases and review of the literature, we provide recommendations to assist clinicians in managing this uncommon but vision-threatening condition and minimizing complications.

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

“…The iris tissue is rich in blood vessels, which can provide an appropriate environment for the implantation and proliferation of epithelial cells. 2,6 However, we tend to consider that the pigmented free-floating iris cyst in this case is more similar to the presentation of a free-floating iris cyst of primary category rather than a common type of secondary iris cyst. In addition to congenital abnormalities, surgery, trauma, medications and tumors are also reported to be associated with free-floating iris cysts.…”

“…The dimensions, shape, location, and adjacent anatomic structures (cornea, lens) of the cysts can be well imaged by UBM. 2,6 AS-OCT is good to image small lesions of anterior segment but it will increase the posterior shadowing, which would lead to an unclear posterior imaging of the lesions. 6,8 In this case, AS-OCT was chosen for examination and the anterior chamber mass was well demonstrated.…”

Delayed Treatment of Secondary Iris Cyst due to Blunt Ocular Trauma

“…Moreover, with advances in diagnostic technology and excellent surgical techniques, secondary iris cysts have become even more uncommon [10]. We report a rare case of secondary iris epithelial cyst following blunt trauma.…”

Sterile iris abscess associated with herpes zoster ophthalmicus

“…However, more invasive surgical excision may be required in the setting of recurrent cysts with significant sequelae. Surgical excision can range from viscoelastic dissection of the cyst, 16 direct cauterization, 17 sector iridectomy, 18 and en bloc resection involving corneoscleral iridocyclectomy with subsequent corneoscleral graft. 19 , 20 Although, iridectomy is not suitable for all symptomatic cysts, it may be a viable option when associated with cataract extraction, as seen in our patient, as it provides a definitive diagnosis and solution for recurrent cysts.…”