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Journal Français d'Ophtalmologie
Volume 37, n° 5
pages e71-e72 (mai 2014)
Doi : 10.1016/j.jfo.2013.07.012
Lettres à l'éditeur

Auto-refractometry may assist in discovering asymptomatic iridociliary cysts
L’autoréfractomètre peut aider à découvrir des kystes iridociliaires asymptomatiques
 

A. Aydin a, b, , I. Kocak b, M. Sabahyildizi c
a Service d’ophtalmologie, clinique universitaire d’ophtalmologie, faculté de médecine, université d’Istanbul Medipol, Istanbul, Turquie 
b Service d’ophtalmologie, hôpital de Nisa, Istanbul, Turquie 
c Service d’ophtalmologie, hôpital d’éducation de Haydarpasa, académie militaire de médecine de Gulhane, Uskudar, Istanbul, Turquie 

Corresponding author. Özel Nisa Hastanesi, Göz Hastalıkları Servisi, Fatih Caddesi, Yenibosna, Turquie.
Introduction

Iris and ciliary body cysts are epithelial-lined spaces arising from the pigmented epithelial layer of the iris and ciliary body [1]. The prevalence of these cysts is reported as 4.9 % in a study using ultrasound biomicroscopy (UBM) [2]. Although they are mostly asymptomatic and stable, large peripheral cysts may cause angle-closure glaucoma in consequence of anterior bowing of peripheral iris [3, 4]. Usually, suspicion for iris cysts may arise due to the detection of a dome-like elevation of iris upon slit lamp examination. Then, a definitive diagnosis can be made following UBM revealing the thin-walled and fluid filled structure of iris cysts that lack internal reflectivity [5]. Recently, a new technique has been described to detect the iridociliary cysts: Roberts has reported a case that shows the utility of infrared photography in the detection of iris and ciliary body cysts based on the iris transillumination method [6]. We also had the opportunity of detecting asymptomatic iris cysts in a patient using real-time infrared sensitive camera of an auto-refractometer during routine eye examination.

Case presentation

The case was a 53-year-old man who presented with the complaint of reduced near vision. His medical history was unremarkable, and he had no past history of ocular trauma, uveitis or ocular surgery. Upon auto-refractometry (Auto-Kerato-Refractometer KR 8900, with B&W infrared sensitive CCD camera, Topcon Co, Tokyo, Japan), real-time infrared image of right iris revealed a well-delineated area with transillumination defect adjacent to inferotemporal limbus (Figure 1A). However, slit lamp examination was normal, and there were no findings such as iris elevation, transillumination defect, or pigment dusting on the corneal endothelium (Figure 1B). Gonioscopy revealed a narrowing of iridocorneal angle in the inferotemporal quadrant of the right eye (Shaffer grade 2). Dilated fundus examination was normal. Intraocular pressure was 16mmHg in the right, and 14mmHg in the left eye. Visual acuity was 20/20 with a hyperopic correction of +1.00 D in both eyes. Based on these findings, iridociliary cysts or tumours of the right eye were suspected, and ultrasound biomicroscopy (UBM, VuMax II, Sonomed Inc, NY, USA) was performed. UBM demonstrated the presence of multiple iridociliary cysts with thin wall and anechoic center, occupying inferotemporal quadrant of the right eye (Figure 1C). The iridocorneal angle was narrow but open in this quadrant. So, the patient was diagnosed with multiple iridociliary cysts of the right eye. He was warned about the possible complications of iridociliary cysts, and was included in a follow-up program.



Figure 1


Figure 1. 

Real-time infrared image obtained by auto-refractometer (A) of right iris revealed a well-delineated area with transillumination defect adjacent to inferotemporal limbus (black arrow). B. Slit lamp examination was normal, and there were no findings such as iris elevation, transillumination defect, or pigment dusting on the corneal endothelium. C. Ultrasound biomicroscopy confirmed the presence of multiple iridociliary cysts with thin wall and anechoic centre, involving inferotemporal quadrant of the right eye.

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Discussion

Infrared transillumination photography of the iris was first described by Saari et al. in 1977 for the visualization of the structural pattern of the stroma and posterior surface of the iris [7]. It has been reported that this imaging technique may be useful in some ocular diseases including Fuchs's heterochromic iridocyclitis, pigmentary glaucoma, and pigment dispersion syndrome [8, 9, 10]. Roberts has showed that iridociliary cysts may be detected using infrared photography [6]. Since real-time infrared sensitive cameras are used in most of auto-refractometers, these iris pathologies may also be noticed during auto-refractometry.

As conclusion, this case shows that auto-refractometers with infrared sensitive camera may assist in the detection of asymptomatic iridociliary cysts. Since auto-refractometry is performed by mostly optometrists and orthoptists in ophthalmology clinics, they should be informed about the new potential use for this examination method. Besides, a detailed study is necessary to evaluate the diagnostic value of the infrared sensitive camera of the auto-refractometers in patients with iris pathologies affecting transillumination such as iridociliary cysts, Fuchs's heterochromic iridocyclitis, pigmentary glaucoma, pigment dispersion syndrome and pseudoexfoliation syndrome.

Disclosure of interest

The authors declare that they have no conflicts of interest concerning this article.


 Présenté lors du 47e Congrès Annuel de la Société Turque d’ophtalmologie, en novembre 2013, Antalya, Turquie.

Références

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Roberts D.K., Chaglasian M.A., Meetz R.E. Iris transillumination defects in the pigment dispersion syndrome as detected with infrared videography: a comparison between a group of blacks and a group of nonblacks Optom Vis Sci 1999 ;  76 : 544-549 [cross-ref]



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