| Abstract [eng] |
Aim of the study. To review and systematize the clinical and diagnostic features, pathogenetic mechanisms, and treatment tactics of glaucoma caused by iridociliary cysts described in the literature and to compare them with the case of Vilnius University Hospital Santaros Klinikos. Objectives. To review the morphology of iridociliary cysts and the mechanisms of intraocular pressure elevation. To review the clinical signs and diagnostic methods of glaucoma caused by iridociliary cysts. To review treatment methods. To present a clinical case of glaucoma caused by iridociliary cysts, comparing it with the systematic review results. Methods. A systematic review was conducted, including 25 articles published between 2006 and 2024, along with a clinical case report. Results. A total of 26 clinical cases (41 eyes) were included in the review. Iridociliary cysts were bilateral in 58% of cases. In 11 eyes (27%) cysts were located only in the iris; in 16 eyes (39%) in both the ciliary body and iris; and in 14 eyes (34%) only in the ciliary body. The most common presentation was multiple nonannular cysts, observed in 21 eyes (51%). The main mechanism of intraocular pressure elevation was iridocorneal contact identified in 30 eyes (73%). Glaucoma was diagnosed in 26 eyes (63%), while in 12 eyes (29%) it was not (including ocular hypertension in 8 eyes). The most frequent symptoms were ocular pain - 9 cases (35%), decreased vision - 9 cases (35%), and ocular redness - 4 cases (15%). Common biomicroscopic findings included a shallow anterior chamber -10 cases (38%), visible cyst or suspicious lesion - 9 cases (35%), iris convexity - 6 cases (23%), corneal opacities - 4 cases (15%), and corneal edema - 4 cases (15%). Gonioscopy most frequently revealed a closed anterior chamber angle in 16 eyes (39%), locally narrowed or closed in 8 eyes (20%), and open in 7 eyes (17%). Ultrasound biomicroscopy was used to confirm the diagnosis in 81% of cases. Medical treatment alone was reported in 9 eyes (22%), interventional treatment alone in 12 eyes (29%), and combined treatment in 20 eyes (49%). Peripheral iridotomies were performed in 15 eyes, phacoemulsification with intraocular lens implantation in 7 eyes, cyclophotocoagulation in 5 eyes, and Nd:YAG cystostomy in 5 eyes. More than one intervention was performed in 15 eyes (37%). Before and after treatment, mild visual impairment was most commonly observed (22 eyes (54%) and 18 eyes (44%), respectively). In 16 eyes (39%), visual acuity remained stable or improved. Mean intraocular pressure significantly decreased from 31.1 ± 10.6 mmHg before treatment to 15.1 ± 6.3 mmHg after treatment. Conclusions. In cases of iridociliary cysts, elevated intraocular pressure and glaucoma were most commonly caused by secondary angle closure due to bilateral, multiple lesions. Iridociliary cysts were often suspected based on a shallow anterior chamber, iris deformation, or a suspicious lesion, as well as a closed anterior chamber angle, while the diagnosis was most commonly confirmed by ultrasound biomicroscopy. The management of glaucoma caused by iridociliary cysts is not standardized and, in many cases, involves a stepwise combination of medical and laser treatment. Most patients underwent laser or surgical interventions, with laser peripheral iridotomy being the most frequently performed procedure. Despite the variability in treatment strategies, effective intraocular pressure control and stable visual acuity were achieved in the majority of patients. |
