Iris stromal cyst management with absolute alcohol-induced sclerosis in 16 patients.

Abstract

IMPORTANCE:

The management of symptomatic iris stromal cyst is challenging using methods of aspiration with or without adjunctive cryotherapy, intracameral cautery, or photocoagulation. Failed cases often require surgical resection, with risks for epithelial downgrowth, glaucoma, blindness, and loss of the eye.

OBJECTIVE:

To study the safety and efficacy of the management of iris stromal cysts with aspiration and alcohol irrigation to induce cyst sclerosis.

DESIGN, SETTING, AND PARTICIPANTS:

Interventional case series at a tertiary referral center among 16 patients.

EXPOSURES:

Microscopically monitored transcorneal aspiration of cysts was performed with a 30-gauge needle on a 3-way T-extension into a 3-mL syringe, followed by immediate infusion of absolute alcohol from a separate 1-mL syringe through the other arm of the T-extension. Subsequent alcohol aspiration and repetition of the cycle was performed until the collapsed cyst wall appeared gray.

MAIN OUTCOMES AND MEASURES:

Cyst involution, visual acuity, and treatment complications.

RESULTS:

The iris stromal cysts were primary congenital (n = 6), primary acquired (n = 4), or secondary (n = 6). The cysts had a median basal diameter of 12 mm and a thickness of 4 mm, occupying 50% or more of the anterior or posterior chamber in each case. Treatment was administered following failure of simple aspiration (n = 16) and additional methods (n = 8). During a median follow-up period of 5 years, treatment was successful in 14 of 15 patients (1 patient was lost to follow-up). Cyst sclerosis with stabilization (n = 1) or involution (n = 13) was achieved following 1 (n = 10), 2 (n = 2), or 3 (n = 2) procedures. The single failure occurred in a 3-year-old child with cyst recurrence and severe photophobia requiring resection. Visual acuity remained stable or had improved in 14 patients and was reduced in 1 patient because of cataract. Complications included transient corneal edema (n = 4) and transient anterior chamber inflammation (n = 1), which resolved following topical corticosteroid therapy. No evidence was seen of treatment-related glaucoma, epithelial downgrowth, tissue necrosis, cataract, posterior segment toxic effects, or need for enucleation.

CONCLUSIONS AND RELEVANCE:

Microscopically monitored aspiration and absolute alcohol-induced sclerosis of iris stromal cysts is safe and effective, with cyst involution obtained in 93% (14 of 15) of patients.

• Authors: Carol L Shields, Sruthi Arepalli, Erin B Lally, Sara E Lally, Jerry A Shields
• Journal: JAMA ophthalmology (JAMA Ophthalmol) Vol. 132 Issue 6 Pg. 703-8 (Jun 2014) ISSN: 2168-6173 [Electronic] United States
• PMID: 24723076 (Publication Type: Evaluation Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Sclerosing Solutions
• Ethanol

Topics

• Adolescent
• Adult
• Age Factors
• Aged
• Child
• Child, Preschool
• Cohort Studies
• Cysts (pathology, therapy)
• Ethanol (therapeutic use)
• Female
• Follow-Up Studies
• Humans
• Infant
• Iris Diseases (pathology, therapy)
• Male
• Middle Aged
• Patient Safety
• Registries
• Retrospective Studies
• Risk Assessment
• Sclerosing Solutions (therapeutic use)
• Sclerosis
• Sclerotherapy (adverse effects, methods)
• Severity of Illness Index
• Stromal Cells (drug effects, pathology)
• Suction (methods)
• Time Factors
• Treatment Outcome
• Young Adult