Ocular Oncology, Cornea, Cataract and Refractive Services, All India Institute of Medical Sciences, New Delhi, India.
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Indian J Ophthalmol. 2024 Nov 1;72(11):1687. doi: 10.4103/IJO.IJO_2897_23. Epub 2024 Oct 26.
Iris cyst can lead to iridocyclitis, angle closure, secondary glaucoma, corneal decompensation, band keratopathy, cataract, subluxation of the lens, or visual disturbance leading to amblyopia or strabismus. Incomplete removal of cyst can lead to recurrence. Recurrent surgeries are more complicated and compromise prognosis. So, complete removal of cyst with minimal anatomical disturbances is essential for better outcomes.
To define a new technique of triple treatment therapy for iris cyst management.
Iris cyst was treated in three steps. In the first step, iris cyst aspiration followed by cyst cavity treatment with mitomycin-C was done. After that, cyst cavity was irrigated with balanced salt solution (BSS). In the second step, the anterior cyst wall was removed with a vitrectomy cutter. In the third step, the posterior cyst wall was cauterized with diathermy.
In this technique, we chose a minimally invasive approach utilizing two 1-mm incisions leading to less astigmatism. Iridectomy was not performed, which led to a small iris defect postoperatively, and pupilloplasty was not required. Injection of mitomycin-C led to destruction of the cyst wall, and diathermy further reduced the chance of recurrence by destroying the cyst base. Postoperatively, mild corneal edema was noted, which resolved in 1 week. Topical steroids were given to control postoperative inflammation. No recurrence has been noted till 6 months of follow-up. The more conservative approach seemed to result in better visual outcomes.
Wide varieties of approaches are available for iris cysts, like laser cystotomy, aspiration, diathermy, cryotherapy, injection of sclerosing agents, and surgery.[1] Yu et al.[2] treated iris cyst in a 60-year-old female with cyst content aspiration using 30G needle, followed by injection of 0.0002 mg/ml mitomycin-C in the cavity for 5 min. BSS wash was given five times at the end. They noted a decrease of 13.3% in endothelial cell count following the procedure. They speculate that transient application of MMC can cause permanent damage to the epithelial and goblet cells that secrete cyst fluid, hence resulting in regression of the cyst. Similarly, Kawaguchi et al.[3] aspirated cyst fluid with a 30G needle and left 0.3 ml of 10-3 mg/ml mitomycin-C for 5 min in the cavity, followed by BSS wash in a 32-year-old female with recurrent iris cyst. They reported a decrease of 4% in endothelial cell count postprocedure. Shen et al.[4] used micro diathermy to treat residual cyst wall attached to the endothelium and base of cyst in four cases. In our case, we have combined cyst aspiration, mitomycin-C, excision using vitrectomy cutter, and diathermy. No recurrence has been observed at the longest follow-up of 3 years. However, a small sample size and less duration of follow-up are the limitations to call it the best approach.
虹膜囊肿可导致虹膜炎、房角关闭、继发性青光眼、角膜失代偿、带状角膜病变、白内障、晶状体半脱位或视力障碍导致弱视或斜视。囊肿不完全切除可导致复发。复发手术更为复杂，并影响预后。因此，为了获得更好的结果，最小程度地破坏解剖结构来完全切除囊肿至关重要。
定义一种治疗虹膜囊肿的三联治疗新技术。
虹膜囊肿分三步治疗。第一步，行虹膜囊肿抽吸术，并用丝裂霉素 C 处理囊腔。之后，用平衡盐溶液（BSS）冲洗囊腔。第二步，用玻璃体切割器切除前囊壁。第三步，用电烙术烧灼后囊壁。
在该技术中，我们选择了一种微创方法，仅使用两个 1mm 的切口，导致的散光更小。未行虹膜切除术，术后仅遗留小的虹膜缺损，且无需行瞳孔成形术。注射丝裂霉素 C 可破坏囊肿壁，电烙术进一步破坏囊肿基底，从而降低复发的机会。术后观察到轻度角膜水肿，1 周内消退。给予局部皮质类固醇以控制术后炎症。在 6 个月的随访中，未发现复发。这种更保守的方法似乎能带来更好的视力结果。
虹膜囊肿有多种治疗方法，如激光囊切开术、抽吸术、电烙术、冷冻疗法、硬化剂注射和手术等。[1] Yu 等人[2]对一名 60 岁女性的虹膜囊肿采用 30G 针头抽吸囊内容物，然后向囊腔注入 0.0002mg/ml 丝裂霉素 C 5min。最后用 BSS 冲洗 5 次。他们发现术后内皮细胞计数减少了 13.3%。他们推测，MMC 的短暂应用可能会对分泌囊液的上皮细胞和杯状细胞造成永久性损伤，从而导致囊肿消退。同样，Kawaguchi 等人[3]对一名 32 岁女性的复发性虹膜囊肿采用 30G 针头抽吸囊液，然后向囊腔中注入 0.3ml 浓度为 10-3mg/ml 的丝裂霉素 C 5min，再用 BSS 冲洗。他们报告术后内皮细胞计数减少了 4%。Shen 等人[4]使用微电烙术治疗附着于内皮和囊肿基底的残余囊肿壁。在我们的病例中，我们结合了囊肿抽吸术、丝裂霉素 C、使用玻璃体切割器切除以及电烙术。在最长 3 年的随访中，未观察到复发。然而，样本量小和随访时间短限制了其成为最佳方法的可能性。
