Acquired Iris Cyst After Iris Fixated Lens Surgery: An Unusual Presentation

To report a case of a iris cyst in a patient with previous intraocular surgery with phakic anterior chamber iris-fixated lens implantation.

Iris cysts are unusually encountered. Briefly they can be classified as congenital or acquired or, more frequently, as primary or secondary. Secondary cysts typically result from penetrating trauma or intraocular surgery. They can also result from uveitis, tumors, parasitic infections among others.  Unlike primary cysts, secondary cysts are more prone to complications such as decreased visual acuity, ocular hypertension, corneal edema and uveitis.

A 39-year-old man presented to the emergency clinic with a 3-day history of ocular hyperemia and discomfort in the left eye. Best corrected visual acuity (BCVA) was 20/125. Anterior segment slit-lamp examination revealed diffuse conjunctival hyperemia, a transparent cornea, an iris fixated lens (Artiflex®) and an iris cyst (3x4mm) located superiorly with inferior displacement of the iris-fixated lens. The crystalline lens was clear. Goldmann applanation tonometry showed elevated intraocular pressure (32 mmHg).

Fundus examination revealed a myopic fundus, but was, otherwise, unremarkable. Visual field and ocular motility examination were normal. Pupillary light reflexes showed an irregular pupil contraction on the left with normal reaction on the right eye.

Right eye evaluation showed BCVA of 20/20 and no abnormal findings.

On further questioning the patient revealed a longtime history of poor vision in the left eye and being submitted to intraocular surgery 12-year prior in a private clinic.

Nd-YAG laser was used on the anterior aspect of the iris cyst with immediate release of clear fluid. The patient was discharged on ocular hypotensive drugs plus topical steroids and follow-up was scheduled. During follow-up the patient reported resolution of his complaints. On anterior segment examination the iris cyst persisted as a residual cyst. Since the patient was asymptomatic with normal intraocular pressure observation no further intervention was made.

Iris cysts are infrequent findings. Most secondary cysts result from penetrating or surgical trauma. Nonetheless it is important to differentiate them from solid tumors. The development of iris cysts after intraocular surgery can occur several years after the procedure which increases de diagnostic challenge. Management of iris cyst can be observation, laser therapy or surgical drainage/excision. Nevertheless, recurrence rate is high.