Abstract
Purpose: :
To demonstrate the use of ultrasound biomiscroscopy (UBM) in recognizing a posterior iris component to an anterior chamber cyst following cataract extraction, necessitating an en bloc excisional approach.
Methods: :
A case report of a patient with an anterior chamber cyst secondary to epithelial downgrowth, with an uncommon posterior iris component visualized by UBM.
Results: :
A 84-year-old female patient with a history of remote cataract extraction complicated by posterior capsular rupture with sulcus intraocular lens implant (IOL) presented with right eye irritation. On examination, her best-corrected visual acuity was 20/20 (right eye) and 20/40 (left eye). Intraocular pressure (IOP) in both eyes was within normal limits. She was noted to have epithelial downgrowth with a translucent 1mm cyst on the superotemporal aspect of the iris. The pupil was peaked toward the cyst and previous corneal wound site. Vitreous was also present to the wound. No anterior chamber (AC) inflammation was present. UBM performed at the time was consistent with an anterior chamber cyst. On repeat examination two years later, the cyst had enlarged, extending over three-clock hours of the superotemporal anterior iris surface with corneal touch. Mild AC reaction was also present. Repeat UBM showed the enlarged anterior chamber cyst with extension to a second cyst posterior to the iris plane, which was not visualized on previous imaging. Over the course of the subsequent year, the patient’s clinical course was complicated by AC inflammation, secondary glaucoma, and IOL dislocation inferiorly. Given the presence of the additional posterior component, corneoscleral block excision with iridocyclectomy and IOL exchange was performed, rather than aspiration of the anterior chamber cyst, to ensure complete excision. After 8 months of post-operative follow-up, the patient has not exhibited any signs of recurrent epithelial downgrowth.
Conclusions: :
Epithelial downgrowth is a rare but significant complication associated with penetrating trauma and anterior segment surgery. This invasion can take the form of an anterior chamber cyst involving the iris and/or cornea. A posterior iris component to the cyst in epithelial downgrowth is much less commonly encountered. While newer tissue-sparing techniques using aspiration and endoscopic photocoagulation have been advocated, we demonstrate the importance of UBM to determine the presence of a posterior cystic component that requires traditional en bloc excision.
Keywords: anterior chamber • anterior segment • cornea: epithelium