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A boy in his teens with no significant medical history, ocular history, or recent trauma was referred by an ophthalmologist for mild photophobia and an iris lesion. The referring clinician initially suspected traumatic iridodialysis and vitreous prolapse. On ophthalmic evaluation, visual acuity was 20/20 OS, intraocular pressure was 13 mm Hg OS, and slitlamp examination of the left eye demonstrated a clear, intrinsically vascularized, cystic lesion extending into the anterior chamber from the peripheral superonasal iris (Figure 1A). The base of the lesion was surrounded by iris atrophy and corectopia was noted. The remainder of the ocular examination was unremarkable. Examination of the right eye was also unremarkable. Ultrasonographic biomicroscopy of the anterior segment demonstrated a large, cystic lesion incorporated in the iris of the left eye with a thickness of 2.2 mm and a maximum radial extent of 6.1 mm (Figure 1B).
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Iris stromal cyst
A. Aspiration with absolute alcohol injection
Pigmented cysts arising from the iris pigment epithelium are the most common type of primary iris cyst.1 They are often of no visual consequence and typically do not require intervention.1 However, iris stromal cysts are likely to enlarge with distortion of surrounding structures and potential consequences of compromised vision, amblyopia, recurrent iridocyclitis, and glaucoma.2,3 Stromal cysts represent approximately 3% of iris tumors, and approximately 40% of iris stromal cysts are congenital.4 Congenital cysts are typically diagnosed in patients younger than 20 years.4
In this case, continued observation was not ideal given the extension into the visual axis and the significant growth over the course of 1 month. Aspiration,3 alcohol sclerosis,5,6 resection,7 and laser treatment8 have all been described; however, we believe aspiration with alcohol sclerosis is the preferred initial approach given that it is less invasive than surgical resection and potentially less inflammatory and less likely to yield recurrence than laser cystotomy.
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Corresponding Author: C. Ellis Wisely, MD, Duke Eye Center, Department of Ophthalmology, Duke University, 2351 Erwin Rd, Durham, NC 27710 (firstname.lastname@example.org).
Published Online: June 20, 2019. doi:10.1001/jamaophthalmol.2019.1651
Conflict of Interest Disclosures: Dr Materin is a paid consultant and advisor for Castle Biosciences outside the submitted work. No other disclosures were reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
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