Inadvertent rupture of iridociliary cyst following transscleral Diode laser
A 56-year-old male presented with chronic on and off pain in the left eye. Other components of medical history were unremarkable. His systemic examination revealed multiple subcutaneous tumors in distal upper limbs and more than 6 café-au-lait macules; but all were <15 mm in diameter. His vision was 20/30 in right eye and counting fingers at 3 feet in left eye. The peripheral anterior chamber was shallow in both eyes. Irises had no nodule. Applanation tonometry readings were 13 mm Hg and 50 mm Hg in right and left eye, respectively. Dark-room gonioscopy showed appositional closure of the drainage angle with multiple peripheral iris convexities in the right eye and 360° synechial angle closure in the left eye. UBM presented a ring-shaped solitary iridociliary cyst spanning 360° in the right and 270°, sparing nasal quadrant, in the left eye. The cysts had hyper-reflectile walls and sonolucent interiors, suggestive of primary neuroepithelial cysts [].\nWe did Nd:YAG laser iridotomy, peripheral to the collarette of the right iris at 8 o′clock hour where the diameter of the cyst was narrowest on UBM to avoid cyst rupture []. Post iridotomy, the angle recess was narrow, but the scleral spur was visible all around on dark-room gonioscopy in the right eye. The right optic disc was healthy, and the left had advanced glaucomatous cupping []. An UBM confirmed patency of the angle recess in the right eye []. Magnetic resonance imaging of brain and orbits was unremarkable, except for a diffuse T2 hyperintense signal in the left optic nerve. Antiglaucoma medications were started in the left eye.\nThe left eye was painful despite maximum antiglaucoma medications. This eye underwent G-probe assisted inferior 180° contact transscleral Diode cyclophotocoagulation (810 nm laser; Iridex Corporation, CA, USA). Post procedure, severe inflammation of the anterior chamber and neovascularization of the iris occurred, which resolved gradually with steroid and cycloplegic eye drops. The cataract in the left eye progressed to maturity. The IOP in the left eye remained between 40 and 48 mm Hg though the patient was pain-free. On repeat UBM, the inferior ciliary processes were shrunken, but the cyst was no longer imaged []. Other UBM, 3 months later, did not show recurrence of the cyst.