A 42-year-old lady came to Out Patient Department (OPD) with complaints of gradually progressive blurring of vision in the right eye for the last 2 months. On examination, she had best-corrected visual acuity (BCVA) of 6/12 and intraocular pressure of 10 mm of HG in the right eye. In slit lamp (SL) examination, the anterior chamber (AC) was shallow temporally (Van Herick grade II), and there was a mass from the right side of the iris occluding the pupil partially Fig. 1a. Ultrasound biomicroscopy (UBM) and anterior segment optical coherence tomography (AS-OCT) showed an iris cyst with anterior lens capsular (ALC) touch Fig. 1b, c. A diagnosis of primary iris cyst was made and was treated conservatively.1 In view of the disease progression, the patient was planned for intracystic sclerosant injection and cyst aspiration.2–5Figure 1: (a) Preoperative SL photo in diffuse illumination showing the iris cyst. (b) Preoperative UBM showing the posterior extent of the cyst, which is touching the ALC (yellow arrow). (c) Preoperative AS-OCT showing anterior bowing of the iris temporally and the cyst touching the ALC near the pupil (red star) done in dilated pupil. (d) Postoperative SL in diffuse illumination. (e) Postoperative UBM showing no remnant of iris cyst. (f) Intraoperative image through the viewing microscope, showing the visible shrinkage of the cyst on being aspirated with 30-gauge needle introduced through the inferior corneal port. (g and h) Intraoperative image showing the three-way cannula system being attached to two 1 mL syringes and the 30-gauge needle that was used. Through one (orange arrow), the cyst was aspirated, and through the other (red arrow), absolute alcohol was injected. AS-OCT = anterior segment optical coherence tomography, ALC = anterior lens capsular, SL = slit lamp, UBM = ultrasound biomicroscopyUnder a peribulbar block, two side ports were made at 6 and 12 o’clock. After injecting viscoelastic substance, the cyst was aspirated with a three-way cannula (attached to 30-gauge needle), and absolute alcohol (99% ethyl alcohol) was injected into the cyst. The cannula was guided by an iris spatula to avoid contact with ALC Fig. 1g, h. The absolute alcohol was kept in the cyst for 2 minutes. The cyst was visibly shrinking Fig. 1f. A thorough AC wash was done, and side ports were sutured.6,7 The postoperative period was uneventful with considerable vision improvement (BCVA 6/9). After 2 months, UBM and SL photo was repeated and the cyst was seen to be completely resolved Fig. 1d,e. On post operative specular microscopy, endothelial counts of both eyes were comparable and within normal range. Discussion This method of draining and injecting sclerosant in a primary iris cyst with a three-way cannula attached to 30-gauge is a very convenient, less time-consuming, and safe procedure with a relatively short learning curve. Hence, this technique can be used avidly in the coming times in similar situations. The only caution that is warranted is taking the help of an assistant either to stabilize the setup or to inject solutions. Authors’ contributions Dipsha Chakraborty: Literature search, data acquisition, manuscript preparation, manuscript editing, and manuscript review. Raj Shekhar Paul: Conceptualization, methodology, definition of intellectual content, manuscript review. The manuscript has been read and approved by all the authors, and the manuscript represents honest work. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.
Chakraborty et al. (Wed,) studied this question.