A unique case of pediatric pigmented epithelial iris cyst masquerading as cataract

A 10-year-old boy presented with diminished vision in his left eye for 2 years. The best corrected visual acuity was 1/60 in the affected eye. On examination, posterior subcapsular cataract was noted, which was more significant toward the temporal part of the lens. Anterior segment optical coherence tomography demonstrated posterior cataractous lens excavation extending into the vitreous. Cataract extraction was performed via an anterior approach, and an intact posterior capsule with fluttering cystic lesion was observed intraoperatively. The cyst was excised, and histopathology confirmed it as benign pigmented epithelial iris cyst. Iris cysts involving the lens are rare in children and may necessitate surgery to achieve favorable visual outcomes.