Lois N, Shields C L, Shields J A, Mercado G
Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Ophthalmology. 1998 Oct;105(10):1879-85. doi: 10.1016/S0161-6420(98)91034-X.
To describe the clinical characteristics, natural course, and complications of a large group of patients with primary iris pigment epithelium (IPE) cysts.
Observational case series.
Two hundred thirty-four patients with primary IPE cysts participated.
Primary IPE cysts were classified as central in 6 patients (3%), midzonal in 50 patients (21%), peripheral in 170 patients (73%), and dislodged in 8 patients (3%). Central (pupillary) IPE cysts were found only in males, peripheral IPE cysts were found most often in females (69%), and no gender predilection was detected for midzonal and dislodged IPE cysts. Central and peripheral IPE cysts occurred in young patients (mean age, 20 and 33 years, respectively), whereas midzonal and dislodged IPE cysts were seen in slightly older patients (mean age, 52 and 45 years, respectively). Central IPE cysts were visible when the pupil was not dilated and appeared most often as a round or collapsed brown lesion arising from the pupillary margin, most commonly superonasally. Midzonal IPE cysts were brown and fusiform, best visualized after pupillary dilation. Peripheral IPE cysts produced a characteristic bulging in the iris stroma near the iris root, but they were directly visible in only 78% of cases. After wide dilation and patient and slit-lamp positioning, they appeared as a round clear lesion behind the iris, most often in the inferotemporal quadrant. Finally, dislodged IPE cysts appeared as a brown oval lesion, free floating in the anterior chamber (12%) or in the vitreous (12%), or fixed in the anterior chamber angle (75%). One hundred twenty-four patients (53%) were followed for a mean of 35 months (range, 3 months-19 years). In these patients, complications associated with IPE cysts included lens subluxation in one case (1%), iritis in one case (1%), focal cataract in two cases (2%), glaucoma in two cases (2%), and corneal touch in five cases (4%).
Primary IPE cysts have characteristic clinical features that serve to differentiate them from intraocular malignancies. Most cysts have a benign clinical course, and treatment is rarely necessary.
描述一大组原发性虹膜色素上皮（IPE）囊肿患者的临床特征、自然病程及并发症。
观察性病例系列研究。
234例原发性IPE囊肿患者参与研究。
原发性IPE囊肿分类如下：中央型6例（3%），中间带型50例（21%），周边型170例（73%），移位型8例（3%）。中央（瞳孔区）IPE囊肿仅见于男性，周边IPE囊肿最常见于女性（69%），中间带型和移位型IPE囊肿未发现性别倾向。中央型和周边型IPE囊肿见于年轻患者（平均年龄分别为20岁和33岁），而中间带型和移位型IPE囊肿见于年龄稍大的患者（平均年龄分别为52岁和45岁）。瞳孔未散大时可看见中央IPE囊肿，最常表现为由瞳孔缘出现的圆形或塌陷的棕色病变，最常见于鼻上象限。中间带型IPE囊肿为棕色、梭形，瞳孔散大后最易看清。周边IPE囊肿在虹膜根部附近的虹膜基质中产生特征性隆起，但仅78%的病例可直接看见。充分散瞳并调整患者和裂隙灯位置后，它们表现为虹膜后方的圆形清亮病变，最常见于颞下象限。最后，移位型IPE囊肿表现为棕色椭圆形病变，自由漂浮于前房（12%）或玻璃体（12%）中，或固定于前房角（75%）。124例患者（53%）平均随访35个月（范围3个月至19年）。在这些患者中，与IPE囊肿相关的并发症包括晶状体半脱位1例（1%）、虹膜炎1例（1%）、局限性白内障2例（2%）、青光眼2例（2%）、角膜接触5例（4%）。
原发性IPE囊肿具有特征性临床特征，有助于将其与眼内恶性肿瘤相鉴别。大多数囊肿临床病程良性，很少需要治疗。
