We describe a free-floating cyst in the anterior chamber after cataract surgery in a 73-year-old woman who underwent uneventful phacoemulsification in her right eye (OD). The best-corrected visual acuity one week after surgery was 20/20 OD; however, six weeks later, she noted the onset of intermittent “shadows” in this eye whenever she changed head position. Slit lamp examination showed a round, free-floating, clear cyst (3–4 mm in diameter) that traversed the central visual axis during eye movement. The cyst was removed through a limbal incision, by expressing it gently out of the eye with viscoelastic injection into the anterior chamber. On pathological examination the inner wall of the cyst was lined with non-keratinised squamous epithelium, typical of ocular surface cells.
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Free floating cyst in anterior chamber after cataract surgeryJoão Baptista NS Malta 1,2, Michael Banitt 1 and H Kaz Soong 1,2
1WK Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI, USA; 2 Department of Ophthalmology, Santa Casa de Misericordia de São Paulo, Brazil
Correspondence: Dr João Baptista NS Malta
Email: WK Kellogg Eye Center, 1000 Wall Street, Ann Arbor, MI 48105, USA; Tel: +734 763 5506; Fax: +734 936 2340.
Date of acceptance: 9th October 2007
The video shows the mobile cyst in the anterior chamber and its subsequent surgical removal.
Note: This video is best viewed in Quicktime
Free-floating anterior chamber cysts are extremely rare.1-3 They may be either congenital or acquired later in life following trauma, surgery or uveal tumors.1 We describe a free-floating cyst in the anterior chamber after cataract surgery.
A 73-year-old woman underwent uneventful phacoemulsification and foldable lens implantation OD. The best-corrected visual acuity OD one week after surgery was 20/20 and the slit-lamp examination was unremarkable. Six weeks later, however, she noted the onset of intermittent ”shadows” in this eye whenever she changed head position. A free-floating cyst in the anterior chamber was noted by the surgeon where upon the patient was referred to our eye center for treatment. Our examination confirmed the presence of a round, free-floating, clear cystic lesion (3-4 mm in diameter) that traversed the central visual axis during saccadic eye movements or whenever the patient lay supine (Fig. 1). The surgical wound appeared intact and there were no signs of iris injury or intraocular inflammation. The dilated fundus examination was normal and the intraocular pressure was 15mmHg.
Figure 1. (a-c): Movement of the cyst with postural changes of the head; (d): Gonioscopic view of cyst in the iridocorneal angle.
The cyst was expressed out intactly through a limbal incision with viscoelastic injection into the anterior. Subsequent histopathological examination of the cyst showed non-keratinized squamous epithelial cells. The visual acuity at one week after cyst removal was 20/25+2.
A variety of cysts can occur in the anterior chamber. Congenital iris stromal cysts are common in children and iris pigment epithelial cysts may be seen in young or middle-aged individuals.2,3 Histopathologically, such cysts consist of an inner wall of iris pigment epithelium with pigment granules.2 In our patient, the inner lining of the cyst contained non-keratinized squamous epithelium, typical of ocular surface cells. If left alone, free-floating cysts can either remain stable or grow in size, causing visual disturbances, secondary glaucoma, and corneal edema. Treatment recommendations include observation or excision.
- Singh G, Narendran K, Saravanan VR, et al. Pigmented free-floating iris cysts. Br J Ophthalmol 2007;91:1037.
- Paysse EA, Coats DK. Free-floating cyst in the anterior chamber. Arch Ophthalmol 1998;116:1256-7.
- Shields JA, Shields CL, DePotter P, et al. Free-floating cyst in the anterior chamber of the eye. J Pediatr Ophthalmol Strabismus 1996;33:330-1.
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