Glaucoma due to ciliary body cysts and pseudoplateau iris: a systematic review of the literature

Schmalfuss, Tiago Ribeiro; Picetti, Egidio; Pakter, Helena Messinger

doi:10.5935/0004-2749.20180051

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REVIEW ARTICLE • Arq. Bras. Oftalmol. 81 (3) • May-Jun 2018 • https://doi.org/10.5935/0004-2749.20180051 copy

Glaucoma due to ciliary body cysts and pseudoplateau iris: a systematic review of the literature

Glaucoma associado a cistos de corpo ciliar e íris pseudoplateau: revisão sistemática da literatura

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The diagnosis of angle-closure glaucoma secondary to iridociliary cysts is challenging and lacks compiled literature support. We present a rare case of bilateral angle-closure glaucoma associated with pseudoplateau iris due to multiple ciliary cysts and conducted a systematic review of the literature to find similar case reports published between November 2006 and November 2016. Only 19 case reports present treatment modalities, and most cases required more than one therapeutic approach for controlling the intraocular pressure. Pseudoplateau iris attributed to iridociliary cysts should be considered in the differential diagnosis of patients with narrow angles, particularly those with ocular hypertension and glaucoma, in which management is complex. In addition to gonioscopy, ultrasound biomicroscopy is considered the conclusive method for accurate diagnosis.

Keywords:
Angle-closure glaucoma; Cyst complications; Ciliary body; Iris diseases; Ultrasound biomicroscopy; Differential diagnosis Pseudoplateau iris

Study	Year	Country	Case	Gender	Age	Eye	Cyst	Angle	Elevated IOP	Glauc.	Treatments	Outcomes
Schmalfuss et al.	2016	Brazil	1	F	54	RE	Multiple	Narrow/closed	Yes	Yes	Drug therapy without pilocarpine → iridotomy → drug therapy including pilocarpine	Controlled IOP
Schmalfuss et al.						LE	Multiple	Narrow/closed	Yes	Yes	Drug therapy without pilocarpine → iridotomy → drug therapy including pilocarpine	Controlled IOP
Berkani Kitouni et al.⁽⁹⁾9 Berkani Kitouni Z, Kitouni Y, Boukhecham D, Kherroubi R, Hartani D. [Plateau-like iris configuration secondary to multiple iridociliary cysts: case report of one family]. J Fr Ophtalmol. 2015;38(3):e41-2. French. ^* * only one eye involved in each case;	2015	Algeria	2	M	55	LE	Multiple	Narrow/closed	No	No	Iridotomy	Angle opened
				F	58	LE	Multiple	Narrow/closed	No	No	Iridotomy	Angle opened
Ispa-Callén et al.⁽¹⁰⁾10 Ispa-Callén MC, Lara-Medina J, Zarco-Tejada JM, López-Mondéjar E, Celis-Sánchez J, González-Del-Valle F. [Argon laser iridoplasty as treatment of plateau-like iris configuration secondary to multiple ciliary body cysts: long-term follow-up by ultrasound biomicroscopy]. Arch Soc Esp Oftalmol. 2009;84(11):569-72. Spanish.	2009	Spain	1	M	37	RE	Multiple	Narrow/closed	Yes	NR	Iridotomy → drug therapy without pilocarpine	Controlled IOP
						LE	Multiple	Narrow/closed	Yes	NR	Iridotomy → iridoplasty → drug therapy without pilocarpine	Controlled IOP
Ang et al.⁽¹¹⁾11 Ang GS, Bochmann F, Azuara-Blanco A. Argon laser peripheral iridoplasty for plateau iris associated with iridociliary cysts: a case report. Cases J. 2008;1(1):368.	2008	Switzerland	1	M	53	RE	Multiple	Narrow/closed	Yes	No	Iridotomy	Stable IOP
						LE	Multiple	Narrow/closed	Yes	No	Iridotomy → iridoplasty	Stable IOP
Vila-Arteaga et al.⁽¹²⁾12 Vila-Arteaga J, Díaz-Céspedes RA, Suriano MM. Plateau iris secondary to iridociliary cysts. Arch Soc Esp Oftalmol. 2015;90(11):542-5.	2015	Spain	1	F	63	RE	Multiple	Narrow/closed	Yes	Yes	Drug therapy without pilocarpine → iridotomy + iridoplasty → phacoemulsification	Controlled IOP
						LE	NR	Open	No	NR	NR	NR
Kaushik et al.⁽¹³⁾13 Kaushik S, Ichhpujani P, Kaur S, Singh Pandav S. Optic disk pit and iridociliary cyst precipitating angle-closure glaucoma. J Curr Glaucoma Pract. 2014;8(1):33-5.	2014	India	1	F	40	RE	Multiple	Narrow/closed	Yes	Yes	Drug therapy without pilocarpine → iridotomy → drug therapy without pilocarpine	Controlled IOP
						LE	NR	Narrow/closed	No	No	Iridotomy	Controlled IOP
Le Corre et al.⁽¹⁴⁾14 Le Corre A, Dot C, Feraoun M, Burelle X, Grasswill C, Perrenoud F, et al. [Plateau iris-like configuration resulting from numerous iridociliary cysts]. J Fr Ophtalmol. 2009;32(7):501-4. French.	2009	France	1	F	35	RE	Multiple	Narrow/closed	Yes	No	Iridotomy → drug therapy without pilocarpine	Controlled IOP
						LE	Multiple	Narrow/closed	No	No	NR	Controlled IOP
Baba et al.⁽¹⁵⁾15 Baba T, Hirooka K, Takagishi M, Sato S, Shiraga F. Plateau iris syndrome associated with cysts and nocturnal elevation of intraocular pressure. Can J Ophthalmol. 2008;43(6):725.	2008	Japan	1	F	38	RE	Multiple	Narrow/closed	Yes^† † nocturnal IOP elevation;	No	Iridotomy → drug therapy with pilocarpine	Controlled IOP
						LE	Multiple	Narrow/closed	Yes^† † nocturnal IOP elevation;	No	Iridotomy → drug therapy with pilocarpine	Controlled IOP
Pathak-Ray et al.⁽¹⁶⁾16 Pathak-Ray V, Ahmed II. Phaco-endocycloplasty: a novel technique for management of ring iridociliary cyst presenting as acute angle closure. Oman J Ophthalmol. 2016;9(1):63-5.	2016	Canada	1	F	63	RE	Single	Open	No	No	NR	NR
						LE	Ring	Narrow/closed	Yes	Yes	Drug therapy without pilocarpine → phacoemulsification + IOL + e ndocycloplasty 210°	Controlled IOP
Seki et al.⁽¹⁷⁾17 Seki M, Fukuchi T, Yoshino T, Ueda J, Hasebe H, Ueki S, et al. Secondary glaucoma associated with bilateral complete ring cysts of the ciliary body. J Glaucoma. 2014;23(7):477-81.	2014	Japan	1	F	33	RE	Ring	open	No	NR	NR	NR
						LE	Ring	Narrow/closed	Yes	Yes	Drug therapy (?) → lens extraction + implantation of IOL by VVPP → anterior capsulotomies + posterior synechiolysis	Controlled IOP
Choudhari et al.⁽¹⁸⁾18 Choudhari NS, Amula GM, Neog A. Inadvertent rupture of iridociliary cyst following transscleral Diode laser. Indian J Ophthalmol. 2013;61(3):124-6.	2013	India	1	M	56	RE	Ring	Narrow/closed	No	No	Ruptura do cisto com Nd:YAG laser iridotomy	Controlled IOP
						LE	Ring	Narrow/closed	Yes	Yes	Drug therapy (?) → contact transscleral Diode cyclophotocoagulation 180° below	Uncontrolled IOP
Mosaed et al.⁽¹⁹⁾19 Mosaed S, Jacobsen BH, Lin KY. Case report: imaging and treatment of ophthalmic manifestations in oculodentodigital dysplasia. BMC Ophthalmol. 2016;16:5.	2016	USA	1	F	6	RE	Multiple	Narrow/closed	Yes	Yes	Drug therapy without pilocarpine → Baerveldt Glaucoma Implant	Controlled IOP
						LE	Multiple	Narrow/closed	Yes	Yes	Drug therapy without pilocarpine → Baerveldt Glaucoma Implant	Controlled IOP
Curtin et al.⁽²⁰⁾20 Curtin J, Moloney G, Grigg J, Sharota Franzco D. Clinical characterization and proposed mechanism of juvenile glaucoma-a patient with a chromosome 4p deletion, Wolf-Hirschhorn Syndrome. Ophthalmic Genet. 2010;31(3):135-8.	2010	USA	1	M	22	RE	Multiple	Narrow/closed	Yes	Yes	Drug therapy without pilocarpine	Controlled IOP
						LE	Multiple	Narrow/closed	Yes	Yes	Drug therapy without pilocarpine	Controlled IOP
Gabriel et al.⁽²¹⁾21 Gabriel LA, Sachdeva R, Marcotty A, Rockwood EJ, Traboulsi EI. Oculodentodigital dysplasia: new ocular findings and a novel connexin 43 mutation. Arch Ophthalmol. 2011;129(6):781-4. ^ only one of the reported cases meets the criteria of this study;	2011	USA	1	F	2	RE	multiple	Narrow/closed	Yes	NR	drug therapy (?)	Controlled IOP
						LE	Multiple	Narrow/closed	Yes	NR	Drug therapy (?) → trabeculectomy + drug therapy (?) → pars plana lensectomy + vitrectomy + glaucoma shunt valve	Controlled IOP
Katsimpris et al.⁽²²⁾22 Katsimpris JM, Petropoulos IK, Sunaric-Mégevand G. Ultrasound biomicroscopy evaluation of angle closure in a patient with multiple and bilateral iridociliary cysts. Klin Monbl Augenheilkd. 2007; 224(4):324-7.	2007	Greece	1	F	82	RE	Multiple	Narrow/closed	Yes^†† †† dark room prone position or mydriasis increased IOP;	Yes	None	NR
						LE	Multiple	Narrow/closed	Yes^†† †† dark room prone position or mydriasis increased IOP;	Yes	None	NR
Aykan et al.⁽²³⁾23 Aykan U, Yildirim O. Combined laser treatment in a patient with pigment dispersion secondary to a large iris pigment epithelial cyst. Balkan Med J. 2012;29(3):339-42.	2012	Turkey	1	M	30	RE	Multiple	Open	Yes	No	Drug therapy without pilocarpine → Nd:YAG laser iridocystotomy + selective laser trabeculoplasty 180° below	Controlled IOP
						LE	Multiple	Open	Yes	No	Drug therapy without pilocarpine → Nd:YAG laser iridocystotomy + selective laser trabeculoplasty 180° below	Controlled IOP
Aydin et al.⁽²⁴⁾24 Aydin A, Kocak I, Sabahyildizi M. Auto-refractometry may assist in discovering asymptomatic iridociliary cysts. J Fr Ophtalmol. 2014; 37(5):e71-2.	2014	Turkey	1	M	53	RE	Multiple	Narrow at cyst	No	NR	NR	NR
						LE	NR	NR	No	NR	NR	NR
Baile et al.⁽²⁵⁾25 Baile R, Sahasrabuddhe M, Nadkarni S, Karira V, Kelkar J, Bhonde S. Bilateral multiple primary iridociliary cysts - A rare case report. Saudi J Ophthalmol. 2011;25(1):89-91.	2011	India	1	M	69	RE	Multiple	Narrow at cyst	Yes^††† ††† mydriasis increased IOP; (?) not detailed	NR	Drug therapy (?)	NR
						LE	Multiple	Open	Yes^††† ††† mydriasis increased IOP; (?) not detailed	NR	Drug therapy (?)	NR
Rivero et al.⁽²⁶⁾26 Rivero V, Aparicio MJ, Suárez-Leoz M, Fernández A. Vitreous hemorrhage secondary to iridociliary cyst. Arch Soc Esp Oftalmol. 2015;90(12):600-3.	2015	Spain	1	M	18	RE	NR	Open	No	No	NR	NR
						LE	Multiple	Open	No	No	NR	NR
Khan et al.⁽²⁷⁾27 Khan AO, Al-Assiri A. Lens coloboma associated with a ciliary body cyst. Ophthalmic Genet. 2007;28(4):208-9.	2007	USA	1	F	7	RE	Single	NR	NR	NR	NR	NR
						LE	NR	NR	NR	NR	NR	NR

Subclassification and number of eyes
						Glaucoma damage	4
				Pseudoplateau	14	Described only high IOP or IOP peaks	8
				Pseudoplateau	14	Described only high IOP or IOP peaks	8
						Normal IOP	2
		Narrow/closed angle	22			Glaucomatous damage	6
Multiple cysts	27			Pseudoplateau iris not described	8	Described only high IOP or IOP peaks	2
						Normal IOP	0
		Narrow/oclusivel angle on the cyst area	2	Glaucomatous damage			0
		Narrow/oclusivel angle on the cyst area	2	Elevated IOP when mydriasis			1
		Open angle	3	Glaucomatous damage			0
		Open angle	3	Ocular hypertension			2
Ring cyst	5	Narrow/closed angle	5	Glaucomatous damage			3
Single sector cyst	3			Not evaluable

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[1] Corresponding author: Tiago Schmalfuss. Rua Francisco Trein, 596 - Porto Alegre, RS - 91350-200 - Brazil. E-mail: tiagoschmalfuss@gmail.com