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Correlation Between Presence of Primary Iris- and Cilliary Body Cysts and Intraocular Pressure

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Correlation Between Presence of Primary Iris- and Cilliary Body Cysts and Intraocular Pressure European Review for Medical and Pharmacological Sciences 2017; 21: 3985-3989 Correlation between presence of primary iris- and cilliary body cysts and intraocular pressure R. ZHU, L. CHENG, D.-M. WANG Institute of Xuzhou Eye Prevention and Control, Department of Ophthalmology, the First People’s Hospital of Xuzhou City, Jiangsu Province, China Abstract. – OBJECTIVE: The objective of this diagnostic imaging test that makes it possible to study was to examine the correlation between visualize the anterior segment of the eye inclu- the presence of primary iris-ciliary cysts and the ding the cornea, iris, and ciliary body1. An UBM intraocular pressure. PATIENTS AND METHODS: exam allows to ophthalmologists to view parts of Sixty patients with the eye including iris and ciliary cysts that would short-sightedness undergoing routine examina- 2 tion for laser vision correction in our hospital otherwise not be visible . in 2003 were enrolled. Patients with known high It has been found in clinical practice that pa- intraocular pressure and risk of glaucoma were tients with iris and ciliary cysts usually experien- excluded from the study. A total of 119 eyes ce no severe symptoms and required no special were examined by the Ultrasound Biomicroscope treatment. However, their intraocular pressure (UBM), and the presence of the primary iris-ciliary may be slightly higher than normal, though iris cysts was confirmed. Intraocular pressure was measured by using a blowing tonometer for each and ciliary cysts also occurred in people with 3 eye in triplicate. Through Pentacam correction of normal intraocular pressure . It was reported that intraocular pressure using the Ehlers formula, the cysts were the main cause of glaucoma and closu- influence of the thickness of central cornea on re glaucoma was secondary to iris-ciliary cysts. intraocular pressure was excluded. To elucidate the correlation of these two condi- RESULTS: Among all participants, 62 eyes tions, we examined the intraocular pressure in (52.1%) were with high myopia, 57 eyes (47.9%) with low and moderate myopia, 27 eyes (22.7%) patients with iris and ciliary cysts who underwent with single cyst, 20 eyes (16.8%) with multiple UBM examination and received treatment in our cysts, and 72 eyes (60.5%) were free from cysts. refractive correction and laser center. Statistical Moreover, the intraocular pressure was found analyses were performed on collected data to as- within the normal range in 72 eyes (60.5%), and sess the relationship between intraocular pressure abnormally high in 47 eyes (39.5%). and the presence of iris and ciliary cysts. CONCLUSIONS: Our results showed that the presence of primary iris-ciliary cysts and the intraocular pressure were positively correlated, with a correlation coefficient of 0.235 (p = 0.01). Patients and Methods These findings may prove useful for prediction and screening of high intraocular pressure. Patients The protocol of this study was approved by the Key Words Iris and ciliary cysts, Intraocular pressure, Ultra- Ethic Committee of the First People’s Hospital of sound biomicroscope (UBM), Pentacam. Xuzhou City. Signed patients’ consent was obtai- ned before participation. We recruited 60 patients (119 eyes) in this study, among them were 31 males (61 eyes) and Introduction 29 females (58 eyes), aged between 18 years-old and 40 years-old (mean age 29 ± 6 yr-old). The Primary iris and ciliary cysts, usually deve- inclusion criteria were: (1) to fully anestheti- loped in the iris or ciliary body, are a common ze ciliary with compound tropicamide and then eye disorder hardly detected by using common confirm the refractive diopter (confirmed by the ophthalmic examinations. Ultrasound Biomicro- MPMVA subjective refraction of phoropter), the scope (UBM) examination is a more advanced refractive diopter could be converted by equiva- Corresponding Author: Ran Zhu, MD; e-mail: [email protected] 3985 R. Zhu, L. Cheng, D.-M. Wang lent sphere lens (diopter of spherical power+1/2 Results diopter of cylindrical power), the diopter was in the range of 1.5D-20D; (2) did not wear corneal Eye Abnormalities Observed contact lens in recent days. Additional inclusion in Study Participants criteria for patients with intraocular hypertension Results showed that among all participants, were: (1) intraocular pressure of one or two eyes 62 eyes (52.1%) were with high myopia, 57 eyes was higher than 21 mmHg, recorded at least twi- (47.9%) with low and moderate myopia, 27 eyes ce after Pentacam correction; (2) without glauco- (22.7) with single cyst, 20 eyes (16.8%) with mul- matous visual field defects; (3) the optic disk and tiple cysts, and 72 eyes (60.5%) were free from retinal nerve fiber were in normal conditions after cysts. Moreover, the intraocular pressure was fundus examination; (4) patients whose chamber found within the normal range (from 10 mmHg angle was open and who didn’t have history of to 21 mmHg) in 72 eyes (60.5%), and abnormally angle closure; (5) had no other possible diseases high (>21 mmHg) in 47 eyes (39.5%). that may lead to increased intraocular pressure. Exclusion criteria were: (1) severe complications Morphological Study of Iris such as keratoconus, uveitis and amotio retinae and Ciliary Cysts (retinal detachmen), (2) previous history of ocu- Results from UBM examination showed that lar injury and operation; (3) short-sighted patients the ciliary cysts were mainly round and oval. The whose sight was not fixed. content was mainly anechoic cystic fluid with good sonolucency. The diameter of these ciliary Methods cysts ranged between 0.1 mm to 2.5 mm (avera- In this study, eye examination was performed ged 0.66 mm). The number of confirmed ciliary using an UBM (Tianjin Suoer Electronics Co, cysts per eye varied from none, one, to multiple Ltd, Tianjin, China). The scanning frequency (Table I). Representative ultrasound biomicrosco- and its range were set at 68 MHz and 5 mm x 5 pe images are shown in Figure 1. mm, respectively. Detailed scanning procedures In regard to the general distribution of these are described as follows. Firstly, the whole cor- ciliary cysts, we defined the positions at 0 o’clock, neal limbus was divided into 8 quadrants. Each 3 o’clock, 6 o’clock and 9 o’clock as the dividing quadrant was done radially and scanned horizon- lines. The whole region was divided into four tally. Secondly, the chamber-angle structure and quadrants, the upper, the lower, the temporal and ciliary body were examined to identify the pre- the nasal. We found that the temporal side was the sence of iris and ciliary cyst. Then, the quantity, most vulnerable site of ciliary cysts, accounting size and anterior chamber angle of the ciliary cyst for 24 cases. There were 22 cases in the lower po- were measured, the latter of which was the mean sition, 3 cases in the upper position and 2 in the measurements obtained from the upper, lower, nasal side. Most of them were located the crown temporal and nasal positions, defined by using the of ciliary cysts and at the back of iris root. positions at 0 o’clock, 3 o’clock, 6 o’clock and 9 Moreover, the average value of anterior cham- o’clock as the dividing lines. Moreover, the intra- ber angle, measured by UBM, was 36.795 ± 4.039. ocular pressure was measured by using a blowing Results from statistical analysis showed that the tonometer (or non-contact tonometer). Three me- presence of primary iris-ciliary cysts and the in- asurements were taken for each eye by the same traocular pressure were positively correlated, with doctor, and mean values were reported. Additio- a correlation coefficient, R of 0.235 and p=0.01 nally, the thickness of cornea was measured via (data not shown). Our results also showed strong Pentacam1, and its impact on Pentacam was eli- positive correlations between intraocular pressure minated 4. Statistical Analysis Table I. Classification of the presence of primary iris- SPSS 19.0 software (SPSS Inc., Chicago, IL, cilliary cysts in study participants according to the level of USA) was employed to perform statistical analy- intraocular pressure (cases). ses by calculating the Spearman correlations, Intraocular No Single Multiple efficiency between intraocular pressure and the pressure cyst cyst cysts presence of iris and ciliary cysts, their size, the High 21 14 12 thickness of cornea and diopter. p<0.05 was con- Normal 51 13 8 sidered statistically significant 3986 Correlation between presence of primary iris- and cilliary body cysts and intraocular pressure A B C D Figure 1. Representative images showing the presence of ciliary cysts. A, No cyst in the ciliary groove; B, Multiple cysts in the ciliary groove, one in the back of the iris root and one in the crown of the ciliary body; C, Single small cyst; D, Large single cyst. with the number and the size of iris and ciliary gy to observe sectional images5. Usually, it uses cysts (R= 0.278 and 0.330, respectively, p<0.05), high transducer frequency (>40 MHz), and the (Table II). Strong negative correlations between imaging range covers an area of 5 mm x 5 mm anterior chamber angle with the intraocular pres- to 8 mm x 12 mm, with a high resolution, up to sure and the size of ciliary cysts were also evi- 20 µm6. It could not only be used to observe the denced, with R= -0.449 and -0.255, respectively anterior segment, but also to show the posterior (p≤0.005), (Table III). segment that most examination tools may hardly reach2. In our laser center, iris and ciliary cysts were detected in some of the patients who had Discussion high intraocular pressure confirmed via the UBM examination.
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