Elsevier

Ophthalmology

Volume 105, Issue 7, 1 July 1998, Pages 1317-1322
Ophthalmology

Primary iris stromal cysts: A report of 17 cases

https://doi.org/10.1016/S0161-6420(98)97041-5Get rights and content

Abstract

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.

Section snippets

Patients and methods

The medical records of all patients with primary iris stromal cysts, examined at the Oncology Service at Wills Eye Hospital between January 1974 and December 1996, were retrospectively reviewed. A total of 17 consecutive patients were included in the study.

The data collected included patient demographics, referring diagnosis, associated systemic and ocular diseases, history of previous trauma or amniocentesis, and use of topical medications. The patients’ symptoms, affected eye, intraocular

Results

Seventeen patients, nine females and eight males, were identified. Nine patients were diagnosed with primary iris stromal cyst under age 10, and eight patients were diagnosed at an older age. Results in both group of patients, 10 years of age or under (children) and over 10 years of age (teenagers and adults), were analyzed separately.

Discussion

Primary, or spontaneous, cysts of the iris stroma are uncommon. Most of the experience accumulated has been based on single case reports3, 6, 7, 8, 9, 10, 11, 15, 16, 17, 18, 19, 20, 23, 26, 27, 28, 29, 30 or small series.2, 4, 5, 12, 13, 14, 32 These cysts have been found most often in children during the first year of life,3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 and few cases have been described in adults.2, 15, 16, 17, 18, 19, 20, 21 There appears to be no sex predilection.3, 4, 5, 6, 7, 8, 9

References (38)

  • D. Guerry et al.

    Spontaneous cyst of the iris stroma

    Am J Ophthalmol

    (1957)
  • V. Rummelt et al.

    Congenital nonpigmented epithelial iris cyst after amniocentesis. Clinicopathologic report on two children

    Ophthalmology

    (1993)
  • S. Merin et al.

    Uniocular congenital blindness as a complication of midtrimester amniocentesis

    Am J Ophthalmol

    (1980)
  • J.A. Shields

    Primary cysts of the iris

    Trans Am Ophthalmol Soc

    (1981)
  • T. Harisson Butler

    A case of cyst of the iris

    Trans Ophthalmol Soc UK

    (1921)
  • G. Naumann et al.

    Spontaneous nonpigmented iris cysts

    Arch Ophthalmol

    (1967)
  • J. Hvidberg-Hansen et al.

    Congenital iris cyst. A case studied by light and electron microscopy

    Acta Ophthalmol (Copenh)

    (1972)
  • H.S. Sugar et al.

    Congenital epithelial cysts of the iris stroma

    Ann Ophthalmol

    (1982)
  • Cited by (68)

    • Intraoperative optical coherence tomography guided iris stromal cyst treatment with absolute alcohol injection

      2022, American Journal of Ophthalmology Case Reports
      Citation Excerpt :

      This eventually leads to intraocular complications including angle closure and glaucoma, necessitating surgical intervention.1 Simple aspiration of the iris stromal cyst alone may not be adequate as it tends to recur, especially if it is secondary to trauma or ocular surgery.1,3,4 Shields et al. reported a case series of 16 patients with iris stromal cysts treated with absolute alcohol to induce sclerosis.1

    • Implantation iris cysts developing 24 years after penetrating keratoplasty

      2022, American Journal of Ophthalmology Case Reports
      Citation Excerpt :

      They do not usually lead to complications and therefore do not need to be treated. Implantation cysts of the iris are rarer tumors.3 They are due to the presence of an ectopic epithelium cell inside the iris stroma.

    • Bilateral congenital stromal iris cyst with secondary glaucoma

      2022, American Journal of Ophthalmology Case Reports
      Citation Excerpt :

      Primary iris cysts are usually asymptomatic owing to their stationary or slow-growing nature and are usually an incidental diagnosis. They are more aggressive in younger children and present with secondary complications like glaucoma, uveitis, strabismus, or amblyopia.2,5 Our patient had raised IOP in both eyes.

    • Sterile iris abscess associated with herpes zoster ophthalmicus

      2021, American Journal of Ophthalmology Case Reports
      Citation Excerpt :

      There are various treatment modalities regarding primary and acquired cysts. Congenital iris stromal cysts in children under ten usually require surgical intervention as cysts can rapidly enlarge and rupture, resulting in iritis and glaucoma.9 However, congenital cysts in adolescents or adults only require intervention in about 25% of cases.6

    • Iris cysts: A comprehensive review on diagnosis and treatment

      2018, Survey of Ophthalmology
      Citation Excerpt :

      Although primary cysts are thought to be congenital, and most of them follow an indolent, stationary, and asymptomatic course (even cases of spontaneous regression have been reported), they sometimes grow slowly over time.4,19,97,176,203 Primary iris stromal cysts usually remain stable in adults, but seem to have a tendency to enlarge and affect the visual axis or cause secondary complications in children.109,138 Depending on the rate of enlargement, symptoms may be delayed until adolescence or early adulthood.206

    View all citing articles on Scopus

    Support provided by the Fundación Pedro Barrié de la Maza, La Coruña, Spain; the Eye Tumor Research Foundation, Philadelphia, Pennsylvania; and the Andres Soriano Cancer Research Foundation, Manila, Philippines.

    View full text