Implantation iris cysts developing 24 years after penetrating keratoplasty

Abstract

Purpose: To report a case of iris implantation cysts occurring 24 years after penetrating keratoplasty and its management.

Observations: A 60-year-old man was referred for diagnosis and management of white iris masses of the right eye. He had undergone bilateral penetrating keratoplasty 24 years before without complication. The clinical findings were suggestive of iris implantation cysts and Ultrasound Biomicroscopy (UBM) and anterior-segment optical coherence tomography confirmed the diagnosis. The patient did not develop any ocular complications from the cysts after one-year follow-up from the diagnosis of iris implantation cysts.

Conclusions and importance: Iris implantation cysts are rare benign tumors that develop after the ectopic implantation of epithelial cells within the iris stroma. They can be congenital or secondary to penetrating trauma or surgery. Their diagnosis relies on clinical examination and UBM. In case of intraocular complications, treatment may be required, otherwise observational follow-up is appropriate.

Keywords: Iris cyst; Ocular tumor; Penetrating keratoplasty; Ultrasound biomicroscopy.

Fig. 1

Right eye biomicroscopy showing epithelial implantation cysts on the iris mimicking an iris tumor, following uneventful full-thickness keratoplasty in a 60-year old male patient. A.Before pupil dilation. B. After pupil dilation (note the regression of conjunctival hyperhaemia after topical neosynephrine).

Fig. 2

Right eye gonioscopy showing the iris implantation cysts in the superior quadrant, without invasion of the iridocorneal angle beyond the margins of the lesion.

Fig. 3

Right eye ultrasound biomicroscopy (UBM) of the cysts. A and B. Vertical and horizontal sections of the cystic lesion. C. Measurements of the dimensions of the lesion. D. Doppler mode showing the absence of intralesional or parietal vascularization supporting the diagnosis of benign cysts. Note the blood flow detected in the ciliary body and iris adjacent to the lesion (color signal) and note in A, C, and D, the coalescence of two cysts, which, besides, have a very thick wall. (Device: Aviso Quantel with 50-MHz probe). (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)

Fig. 4

Anterior-segment optical coherence tomography showing round-shaped lesions with thin hyper-reflective walls, and iso-reflective content, consistent with the diagnosis of iris implantation cysts. A. Vertical section. B. Horizontal section. The cystic lesions were adjacent to an hyperreflective penetrating structure through the cornea, identified as the penetrating keratoplasty scar (arrow).