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Purpose To report the therapeutic effects of ethanol (ETOH) irrigation into epithelial iris cysts (EIC). Study design Retrospective noncomparative interventional case series. Participants 102 eyes of 102 patients aged between 4 and 71 years with EIC, with 4 months to 15 years follow-up. Intervention Under local or general anesthesia, cyst fluid was drained gently via a 27-gauge needle. Without changing the position of the needle, the syringe was replaced with one containing an equal amount of ETOH to the drained cyst fluid, and ETOH was gently irrigated into the cyst. The ETOH was left inside until the cyst wall turned white (about one minute). The ETOH was aspirated and the needle removed. After the irrigation, patients were treated with atropine 1% and dexamethasone 5 ml eye drops. Results Pretreatment findings suggest that the bases of all the cysts were connected either to incisions made during previous operations or to sites of laceration from penetrating trauma. Three types of cysts were identified: single in 88 patients, double in 11 patients, and triple in 3 patients. The cyst wall contained keratic precipitates in three cases, and was vascularized in two cases. Of the 102 cases, 3 were excluded from the study because the EIC was connected to the anterior chamber. Follow-up indicated that 93 cysts resolved after the first irrigation, 3 after the second irrigation and 2 after the third irrigation and 1 case did not respond after third irrigation. The cysts clinically shrank in 78 cases by 1 day after ETOH irrigation and in 20 cases by 2 weeks after ETOH irrigation. Anterior chamber reaction was observed the day after ETOH irrigation in two cases, probably as a result of ETOH leakage, and in nine cases without apparent ETOH leakage. All were treated with dexamethasone 10 ml eye drop for 2 weeks. Intraocular pressure (IOP) normalized in 11 out of 21 cases who had IOP>20 mmHg before ETOH irrigation. Conclusion Ethanol irrigation is a cost-effective and safe procedure, and we recommend consideration of the procedure for treatment of iris epithelial cysts.

Objective To describe the clinical characteristics, natural course, and complications of a large group of patients with primary iris pigment epithelium (IPE) cysts. Design Observational case series. Participants Two hundred thirty-four patients with primary IPE cysts participated. Results Primary IPE cysts were classified as central in 6 patients (3%), midzonal in 50 patients (21%), peripheral in 170 patients (73%), and dislodged in 8 patients (3%). Central (pupillary) IPE cysts were found only in males, peripheral IPE cysts were found most often in females (69%), and no gender predilection was detected for midzonal and dislodged IPE cysts. Central and peripheral IPE cysts occurred in young patients (mean age, 20 and 33 years, respectively), whereas midzonal and dislodged IPE cysts were seen in slightly older patients (mean age, 52 and 45 years, respectively). Central IPE cysts were visible when the pupil was not dilated and appeared most often as a round or collapsed brown lesion arising from the pupillary margin, most commonly superonasally. Midzonal IPE cysts were brown and fusiform, best visualized after pupillary dilation. Peripheral IPE cysts produced a characteristic bulging in the iris stroma near the iris root, but they were directly visible in only 78% of cases. After wide dilation and patient and slit-lamp positioning, they appeared as a round clear lesion behind the iris, most often in the inferotemporal quadrant. Finally, dislodged IPE cysts appeared as a brown oval lesion, free floating in the anterior chamber (12%) or in the vitreous (12%), or fixed in the anterior chamber angle (75%). One hundred twenty-four patients (53%) were followed for a mean of 35 months (range, 3 months-19 years). In these patients, complications associated with IPE cysts included lens subluxation in one case (1%), iritis in one case (1%), focal cataract in two cases (2%), glaucoma in two cases (2%), and corneal touch in five cases (4%). Conclusion Primary IPE cysts have characteristic clinical features that serve to differentiate them from intraocular malignancies. Most cysts have a benign clinical course, and treatment is rarely necessary.

Objective To describe clinical characteristics, management, and complications of primary iris stromal cysts. Design A retrospective review. Results Seventeen consecutive patients with primary iris stromal cysts were found. Nine (52%) patients were diagnosed under age 10 years (range, 1 day-7 years), and eight (47%) patients were diagnosed after age 10 years (range, 14–71 years). Overall, the cyst appeared unilaterally as a solitary clear translucent mass dissecting the iris stroma in all cases. The children with a primary iris stromal cyst demonstrated a more aggressive course than teenagers or adults. In children, the cyst obstructed the visual axis in eight cases (88%), requiring treatment such as aspiration, cryotherapy, and resection. In seven children, multiple treatments were necessary. Ultimate control of the cyst was achieved in all cases using techniques of needle aspiration (with or without cryotherapy) in three cases and using resection in five cases. Primary iris stromal cysts in teenagers and adults necessitated intervention in only two cases (25%). Conclusion Primary iris stromal cysts can occur in children, teenagers, and adults. In children, primary stromal iris cysts appear to have a more aggressive clinical course, often requiring several treatments for globe and vision preservation.

Background: Congenital nonpigmented epithelial iris cysts are not common. They may arise spontaneously from developmental entrapment of surface ectodermal epithelium or from occult ocular trauma prenatally or at birth. Patients and Methods: Between 1989 and 1991, an 8-month-old child and a 6-year-old child presented with large, progressive congenital epithelial iris cysts. Both children had a maternal history of diagnostic amniocentesis after an ultrasound scan, and there was no history of postnatal ocular trauma. The cysts were successfully removed by a modified block excision and tectonic corneoscleral grafting. Results: A dense adherence of the cyst wall to Descemet's membrane resembled old anterior synechiae after occult perforation of the globe in both patients. On histopathologic examination, the epithelial lining of the cysts consisted of non-keratirlizing stratified squamous epithelium with goblet cells resembling conjunctival epithelium. A perforating limbal scar with a corresponding break in Descemet's membrane could be detected in one eye. The long-term visual acuity of both children was encouraging, and there was no evidence of recurrence of the iris cyst during the follow-up period (average, 23 months). Conclusions: The authors conclude that the clinical and histopathologic features of these congenital iris cysts may be consistent with an occult intrauterine limbal perforation of the anterior chamber with a needle during amniocentesis. Amniocentesis, when not guided by a real-time ultrasound scan, may be a risk factor for prenatal ocular trauma, which should be considered in the differential diagnosis of congenital ocular disorders.

Purpose Previously reported clinical outcomes after treatment of congenital iris cysts have been poor, complicated by cyst recurrence and vision loss. Our purpose was to evaluate the outcomes of surgical excision and microdiathermy of congenital iris cysts. Design Interventional retrospective case series. Methods Four patients (3 children, 1 adult) were treated for a congenital iris cyst based on history and clinical presentation. After cyst excision with caution to avoid cyst rupture, the base of the cyst was treated with microdiathermy. Main Outcome Measure Presence or absence of a residual cyst after surgical intervention. Results In all 4 patients, histopathological findings confirmed the diagnosis of a congenital iris cyst. Follow-up periods ranged from 1.4 to 6.2 years (mean ± standard deviation, 4±2). Vision loss did not occur in any of the treated eyes. No cyst recurrence was noted after initial surgical treatment. Conclusion A modern microsurgical technique with adjunctive use of microdiathermy provides improved outcomes in the surgical management of congenital iris cysts. We believe that microdiathermy applied to the base of the cyst removes residual epithelial tissue that accounted for the recurrences documented in previous reports.

A 39-year-old man had an enlarging intrastromal iris cyst that obstructed the chamber angle inferotemporally and abutted the cornea. No history of ocular trauma or previous surgery was present. Iridocyclectomy with en bloc resection of the cyst was performed. The cyst was lined by one to three cell layers of focally pigmented epithelium that ultrastructurally exhibited desmosomes, tonofilaments, terminal bars, and apical microvilli. Additionally, membrane-bound melanin granules (melanosomal complexes) consistent with phagocytized uveal melanin granules were observed. Immunohistochemistry confirmed intracellular keratin. We conclude that the non-traumatic cyst reported herein is of surface ectodermal origin and suggest that such cysts be removed en bloc by sector iridectomy or iridocyclectomy if the lesion has been proven to enlarge.

The records of 200 consecutive patients referred to the Ocular Oncology Service of Wills Eye Hospital because of an iris lesion suspected of being an iris melanoma were reviewed. On clinical evaluation, 24% of the lesions met the criteria for the diagnosis of iris melanoma and 76% were diagnosed as simulating lesions (pseudomelanomas). The most common pseudomelanomas included primary iris cyst (38%), iris nevus (31%), essential iris atrophy (5.7%), iris foreign body (4.5%), peripheral anterior synechia (2.5%), and iris metastasis (2.5%). Less frequently encountered pseudomelanomas included aphakic iris cysts, leiomyoma, melanocytoma, reactive lymphoid hyperplasia, adenoma of iris pigment epithelium, iridoschisis, and other miscellaneous entities. The clinical features that are helpful in differentiating the more common iris pseudomelanomas from true melanomas are discussed. Correct clinical identification of these simulating lesions may prevent unnecessary surgery or other treatment.