Docstoc

Ultrasoung Biomicroscopy Diagnosis of Benign Iris Cyst in Patient

Document Sample
Ultrasoung Biomicroscopy Diagnosis of Benign Iris Cyst in Patient Powered By Docstoc
					    Ultrasound Biomicroscopy
 Diagnosis of Benign Iris Cysts in
Patient Presenting for Implantation
     of Copolymer Phakic IOL

          Muhammad Aman-Ullah MD
            Howard V. Gimbel MD
             Gimbel Eye Centre
             Calgary AB Canada
            ASCRS San Diego 2011


                        Authors Have No Financial Interest
UBM of Iris Cysts in ICL Surgery

 Purpose
  To report a case with a peripheral iris cyst
  diagnosed incidentally during preoperative
  testing for STAAR Visian posterior chamber
  toric implantable copolymer phakic IOL
UBM of Iris Cysts in ICL Surgery

Method
  Routine ultrasound biomicroscopy (UBM
  Sonomed) of the sulcus for determination of
  toric ICL (TICL) length revealed a peripheral
  iris cyst in each eye that was otherwise
  undetected during slit lamp examination
UBM of Iris Cysts in ICL Surgery
Results
•32 year-old male
•Presented for TICL Implantation OU Nov 2009
              OD/OS
              • -11.25 –1.00 X 015 20/15-2
                -11.25 –1.00 X 015 20/15-2
              • Pupil size
                – Mesopic 2.89/3.09 mm
                – Scotopic 5.22/4.64 mm
            • ACD 3.22 mm OU
            • WTW 11.6 mm OU
            • Pachymetry 506/513 um
UBM of Iris Cysts in ICL Surgery
 Results
• High frequency UBM exam (Sonomed VuMaxII)
  – showed bilateral peripheral iris (iridociliary) cysts
     • junction between the iris and ciliary body
     • Cyst in OD is unilateral at 9 o’clock meridian
         – Round, 1.03 mm in diameter
     • Cyst in OS is unilateral at 2:30 o’clock
         – Ovoid, 1.22 x 1.54 mm
     • UBM OU reveals internal echolucency and thin walls typical of
       neuroepithelial cysts
  – UBM STS
     • OD 11.41 mm
     • OS 11.53 mm
UBM of Iris Cysts in ICL Surgery
 Results




      Pre-op cyst OD




                       Pre-op cyst OS
                       Pre-op cyst OS
UBM of Iris Cysts in ICL Surgery
 Results
                 One day pre-op




           Post YAG attempted drainage OS
UBM of Iris Cysts in ICL Surgery
Results                            •7 wks post-op
                                   • UCVA 20/20 OU
                                   • IOP 12 OU


                                            Open angle
                                               Open angle




  TICL temporal haptic in
  sulcus OD

                            TICL temporal haptic
                            pressing into the cyst OS
UBM of Iris Cysts in ICL Surgery
 Results
 •7 mos post-op
 •UCVA 20/15; 20/20               TICL temporal haptic has settled posterior
 •IOP 15/18                           with no pressure on the cyst OS




 TICL temporal haptic remains stable
 in the sulcus OD
UBM of Iris Cysts in ICL Surgery
 Results
 •2.25 yrs post-op
 •UCVA 20/15; 20/20
 •IOP 18 OU



                                           TICL temporal haptic
                                         TICL temporal haptic
                                           pressing into the cyst OS
                                         pressing into the cyst OS




TICL temporal haptic remains stable in
the sulcus OD
UBM of Iris Cysts in ICL Surgery
 Discussion
 •This case report demonstrates the feasibility of implanting
 an ICL with peripheral Iris cysts. No other reports of such
 surgeries were found to compare.

 • UBM systems are suitable for imaging of virtually all
 anterior segment anatomy and pathology, including the
 cornea, iridocorneal angle, anterior chamber, iris, ciliary
 body and lens.

 •UBM is thus applicable for diagnostic
  imaging of corneal diseases, glaucoma,
 cysts and tumors as well as IOL implants.
UBM of Iris Cysts in ICL Surgery
 Conclusion
  •UBM is successful in imaging and diagnosing
  iridocorneal cysts.

  •ICL implantation is possible and remains safe
  even in the presence of peripheral iris cysts.

  •In our case report, UBM exam shows the
  TICLs remain stable in position with long term
  follow up of more than two years.

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:48
posted:4/28/2011
language:English
pages:12