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Abstract #6123 Published in IGR 2-2
Acute bilateral angle-closure glaucoma secondary to ciliary body epithelial cysts of the pars plicata: correlation with the ultrasound biomicroscope
Viestenz A; Bergua A; Mardin CY; Küchle MKlinische Monatsblätter für Augenheilkunde 2000; 217: 127-129
BACKGROUND: Multiple bilateral cysts of the ciliary body corona are rare. Differentiation from solid tumors of the ciliary body is sometimes difficult. PATIENT: A healthy 23-year-old woman developed acute angle-closure glaucoma in mydriasis during ophthalmological examination. The intraocular pressure (IOP) was 14 mmHg in both eyes with normal pupils, and 26 mmHg in the right eye, and 44 mmHg in the left following pupillary dilation. RESULTS: On gonioscopy, there were multiple cysts of the pigmented and nonpigmented ciliary epithelium in both eyes. Ultrasound biomicroscopy disclosed these to be thin-walled cysts with no internal reflectivity. In the right eye, the epithelium of the iris appeared to be separated. The chamber angle was open in miosis. The iris base shifted anteriorly secondary to multiple 2-mm large ciliary body cysts, causing circular angular closure in mydriasis. Bilateral Nd:YAG iridotomy was ineffective. Treatment with pilocarpine 0.5% normalized the IOP in both eyes. CONCLUSIONS: Cysts of the ciliary body can lead to mechanical angle closure. Possible treatment options include: 1. application of miotics; 2. the opening of pigmented cysts by argon laser coagulation of pigmented cysts and Nd:YAG laser coagulation of nonpigmented cysts, provided there are no persisting anterior synechiae; 3. filtering surgery. Cystic epithelial ingrowth has to be ruled out prior to laser treatment since, in case of cystic epithelial invasion, complete removal by en-bloc resection should be achieved. Cystic epithelial ingrowth may be transformed by laser coagulation into diffuse ingrowth with a worse prognosis and, ultimately, loss of the eye. It is possible to differentiate cysts from solid tumors of the ciliary body by means of ultrasound biomicroscopy.
Dr. A. Viestenz, Augenklinik mit Poliklinik der Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054 Erlangen, Germany. Arne.Viestenz@augen.med.uni-erlangen.de
Classification:
9.3.1 Acute primary angle closure glaucoma (pupillary block) (Part of: 9 Clinical forms of glaucomas > 9.3 Primary angle closure glaucomas)
