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

Year 2012, , 339 - 342, 01.03.2012

Ümit Aykan Özlem Yıldırım

https://doi.org/10.5152/balkanmedj.2012.044

Abstract

We reported a case of bilateral extensive iris pigment epithelial cysts masquerading as pigment dispersion. A-30-year-old male patient presented with a dull pain in both eyes and a decreased visual acuity OD. He underwent a complete ophthalmic examination. OD was injected and the cells were graded as +3 and pigmented a +2, in the OS. Intraocular pressures (IOP) were measured as 42 (OD) and 22 (OS) mmHg. Gonioscopy revealed a confluent accumulation of dense pigment in both eyes. Visual fields, peripapillary retinal nerve fiber layer thickness (Spectral OCT/SLO OTI-OPKO Health. Inc, Miami, FL) and optic nerve head tomography (HRT-II Heidelberg Engineering, Heidelberg, Germany) results were within normal limits. On ultrasound biomicroscopy (UBM), bilateral extensive cysts were identified in the midzonal portion of the iris and in the ciliary body. An, antiglaucomatous treatment was started. Then, we decided to perform both Nd:YAG laser iridocystotomyc and selective laser trabeculoplasty. Fourteen months after the combined therapy, the cysts had not recurred, and still apposed and the IOPs were under control without medication Turkish Başlık: Yaygın İris Pigment Epitel Kistine Sekonder Pigment Dispersiyonu Gelişen Hastada Kombine Laser Tedavisi Anahtar Kelimeler: İris-siliyer cisim, pigment dispersiyon sendromu, laser iridokistotomi, laser trabeküloplasti,iris pigment epitel kisti Bu olgu sunumunda pigment dispersiyonunu taklit eden bilateral, yaygın iris pigment epitel kistleri sunulmuştur. Otuz yaşında bir erkek hasta her iki gözünde künt ağrı ve sağ gözde görme keskinliğinde azalma şikayeti ile başvurmuştur. Bu hastaya tam bir göz muayenesi yapılmıştır. Sağ gözde kızarıklık ve grade +3, solda grade +2 pigmente hücre saptanmıştır. Göziçi basınçları (GİB) sağda 42, solda 22 mmHg olarak ölçülmüştür. Gonyoskopide her iki gözde çepeçevre, yoğun pigment birikimi saptanmıştır. Görme alanları, peripapiller retinal sinir lif tabaka kalınlıkları (Spectral OCT/SLO OTI-OPKO Health. Inc, Miami, FL) ve optik sinir başı tomografisi (HRT-II Heidelberg Engineering, Heidelberg, Germany) normal sınırlar içerisinde ölçülmüştür. Ultrason Biyomikroskopi (UBM) ile irisin orta bölgesinde ve siliyer cisimde bilateral yaygın kistler gözlenmiştir. Antiglokomatöz tedavi hemen başlanmış ve daha sonra kombine Nd:YAG laser iridokistotomi ve selektif laser trabeküloplasti uygulanması planlanmıştır. Kombine tedaviden 14 ay sonra yapılan takiplerinde kistlerin tekrarlamadığı, apozisyonun devam ettiği ve GİB'larının ilaçsız olarak normal sınırlar içerisinde seyrettiği kaydedilmiştir.

Keywords

Iris-ciliary body, pigment dispersion syndrome, laser iridocystotomy, laser trabeculoplasty, iris pigment epithelium cyst

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

Abstract

References

• McWhae JA, Rinke M, Crichton AC, Van Wyngaarden C. Multipl bilateral iridociliary cysts: ultrasound biomicroscopy and clinical characteristics. Can J Ophthalmol 2007;42:268-71. [CrossRef]
• Lois N, Shields CL, Shields JA, Mercado G. Primary cysts of the iris pigment epithelium. Clinical features and natural course in 234 patients. Ophthalmology 1998;105:1879-85. [CrossRef]
• Kuchenbecker J, Motschmann M, Schmitz K, Behrens-Baumann W. Laser iridocystotomy for bilateral acute angle-closure glaucoma sec- ondary to iris cysts. Am J Ophthalmol 2000;129:391-3. [CrossRef]
• Kathil P, Chin KJ, Ghaznawi N, Finger PT. Transpupillary Nd:YAG laser cystotomy for iris pigment epithelial cysts with second- ary progressive angle closure. Ophthalmic Surg Lasers Imaging 2011;42:e40-3.
• Honda N, Mimura T, Hotehama A, Usui T, Sugisaki K, Fukuoka S, et al. Laser treatment of giant iris cyst with nanophthalmos. Int Ophthalmol 2011;31:17-20. [CrossRef]
• Pruthi S, Kashani S, Ruben S. Bilateral iris cyst secondary to topi- cal latanoprost. Acta Ophthalmol 2008;86:233-4. [CrossRef]
• Duan X, Zhang Y, Wang N. Laser treatment to large iris cyst secondary to trabeculectomy. Can J Ophthalmol 2007;42:316-7. [CrossRef]
• Alward WL, Ossoinig KC. Pigment dispersion secondary to cysts of the iris pigment epithelium. Arch Ophthalmol 1995;113:1574-5. [CrossRef]
• Chandler PA, Braconier HE. Spontaneous intra-epithelial cysts of iris and ciliary body with glaucoma. Am J Ophthalmol 1958;45:64-74.
• McIlraith I, Strasfeld M, Colev G, Hutnik CM. Selective Laser Tra- beculoplasty as Initial and Adjunctive Treatment for Open-Angle Glaucoma. J Glaucoma 2006;15:124-30. [CrossRef]
• Harasymowycz PJ, Papamatheakis DG, Latina M, De Leon M, Lesk MR, Damji KF. Selective laser trabeculoplasty (SLT) complicated by intraocular pressure elevation in eyes with heavily pigmented tra- becular meshworks. Am J Ophthalmol 2005;139:1110-3. [CrossRef]