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Arundhati Dev Borman, Cecilia Fenerty, Susmito Biswas; Novel management of pediatric iris stromal cysts. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5212.
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© ARVO (1962-2015); The Authors (2016-present)
Pediatric iris stromal cysts are rare and can present with symptoms that affect visual development. Although the anatomical location and etiologies vary, management strategies are varied. We undertook a retrospective observational study of pediatric iris stromal cysts that were successfully managed surgically by fine needle aspiration and injection of antimetabolite, to explore the impact of this treatment on inducing cyst regression.
Pediatric patients attending one UK tertiary ophthalmic center, presenting either with symptoms associated with congenital iris cysts, or who developed the cyst at an older age, were studied. All had examinations under anesthesia (EUAs), imaging studies and surgical management by fine needle aspiration and injection of Mitomycin C. The clinical course was monitored in each child. Cyst contents underwent histopathologic and microbiologic analyses. Investigations to ascertain etiology and possible impact on general health were performed.
All 3 subjects were female with unilateral iris cysts. Subjects 1 and 2 presented at age 5 months and 20 months, with poor vision and photophobia, respectively; Subject 3 developed an asymptomatic iris cyst at age 14 years. In all, this treatment lead to cyst regression after 1 to 2 injections. Cyst contents in all subjects were acellular, and microbiological examinations were negative. Subject 1 presented with visual acuity (VA) of no light perception; her vision has not improved despite cyst resolution as she has an associated retinopathy in this eye. VA in Subject 2 improved from 0.60 to 0.00 logMAR, and her uveitis symptoms settled. No systemic associations were identified in these cases. Subject 3 had Rubenstein Taybi syndrome and congenital glaucoma. She had had multiple surgical procedures bilaterally, including glaucoma filtration surgery. Her VA has not improved due to glaucoma. No intraocular side effects were noted in any subject.
Various management strategies for iris cysts have been described. Observation may be sufficient for iris pigment epithelial cysts but iris stromal cysts often become symptomatic and may need intervention. The surgical methods described include laser, surgical iridectomy and intralesional ethanol or antimetabolites. Few reports exist into the use of Mitomycin C into the cyst cavity in pediatric patients. The present study suggests that this strategy in children is context is safe and successful.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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