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Traitement d'un kyste irien post-traumatique par le laser ND:YAG

To report a case of a post-traumatic peripheral pigment epithelium iris cyst treated with Nd: YAG laser. 

We report a case of a post-traumatic peripheral IPE cyst managed successfully  with Nd:YAG laser cystostomy under corticoticosteroid and anti-glaucoma coverage. 

A 41-year-old woman presented with aching pain and blurred vision in the left eye (LE) after a contusive ocular trauma complicated with hyphema, successfully treated with steroids and anti-glaucoma drugs. However, her vision quality didn’t improve. Gonioscopy through a widely dilated pupil revealed a clear, oval, transparent cyst with mottled pigmentation, located behind the superotemporal iris. It was demonstrated by ultrasound biomicroscopy. It was associated with a focal cataract as the cyst was touching the lens and focal angle closure. It was treated with Nd: YAG laser. A mild flare was documented postoperatively, which resolved in a few days with a topical steroid. 

Iris cysts are grouped as primary and secondary according to their etiology. Then, they are divided according to their histological origin from iris stroma or iris pigment epithelium (IPE). IPE cysts, the most common type, develop as a result of an expansion of the potential space between the pigment epithelial layers of the posterior iris containing clear fluid. Traumatic iris cysts are rare. They may lead to complications such as decreased visual acuity, secondary glaucoma, corneal edema, or uveitis. Peripheral IPE cysts are usually detected on biomicroscopy as a focal shallowing of the anterior chamber and a bulge of the iris stroma. In the absence of a thorough slit lamp examination, it is difficult to detect iris cysts because of their hidden location. Anterior segment optical coherence tomography (ASOCT) and ultrasound biomicroscopy (UBM) are used in differential diagnosis. 

The best treatment is not yet determined and it is unclear whether laser treatment, surgical removal or cyst aspiration with or without laser photocoagulation offers the best chance of control [4]. In this article, we report a case of a post-traumatic peripheral IPE cyst managed successfully with Nd:YAG laser cystostomy under corticosteroid and anti-glaucoma coverage. 

Transpupillary Nd:YAG laser cystotomy offered a minimally invasive and potentially effective treatment for angle-closure induced by post-traumatic pigment epithelium iris cysts.