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Iris cysts in children: classification, incidence, and management. The 1998 Torrence A Makley Jr Lecture
J A Shields1, C L Shields, N Lois
1Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA.
Insights
Most childhood iris cysts are primary pigment epithelial cysts and do not require treatment. However, iris stromal cysts are aggressive and often need aspiration or surgical excision for effective management.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Ocular Oncology
Background:
- Iris cysts in children are rare, with limited data on classification, incidence, and management.
- This study reviews 57 cases of childhood iris cysts to establish their types and incidence.
Discussion:
- Primary pigment epithelial cysts are the most common type (53/57), often peripheral, stationary, and require no intervention.
- Iris stromal cysts (9/57) are progressive, diagnosed in infancy, and necessitate treatment like aspiration or surgical resection.
- Secondary cysts include post-traumatic epithelial ingrowth and tumor-associated cysts.
Key Insights:
- The majority of childhood iris cysts are primary pigment epithelial types, typically benign and self-resolving.
- Iris stromal cysts present a significant contrast, exhibiting aggressive behavior and requiring prompt medical intervention.
- Early diagnosis and appropriate management are crucial, especially for progressive iris stromal cysts.
Outlook:
- Further research into the specific etiologies and long-term outcomes of different iris cyst subtypes in children is warranted.
- Standardized diagnostic criteria and treatment algorithms for pediatric iris cysts will improve patient care.
- Investigating novel, less invasive treatment modalities for aggressive iris stromal cysts could enhance outcomes.
Background:
Iris cysts in children are uncommon and there is relatively little information on their classification, incidence, and management.
Methods:
The records of all children under age 20 years who were diagnosed with iris cyst were reviewed and the types and incidence of iris cysts of childhood determined. Based on these observations recommendations were made regarding management of iris cysts in children.
Results:
Of 57 iris cysts in children, 53 were primary and four were secondary. There were 44 primary cysts of the iris pigment epithelium, 34 of which were of the peripheral or iridociliary type, accounting for 59% of all childhood iris cysts. It was most commonly diagnosed in the teenage years, more common in girls (68%), was not recognised in infancy, remained stationary or regressed, and required no treatment. The five mid-zonal pigment epithelial cysts were diagnosed at a mean age of 14 years, were more common in boys (83%), remained stationary, and required no treatment. The pupillary type of pigment epithelial cyst was generally recognised in infancy and, despite involvement of the pupillary aperture, also required no treatment. There were nine cases of primary iris stromal cysts, accounting for 16% of all childhood iris cysts. This cyst was usually diagnosed in infancy, was generally progressive, and required treatment in eight of the nine cases, usually by aspiration and cryotherapy or surgical resection. Among the secondary iris cysts, two were post-traumatic epithelial ingrowth cysts and two were tumour induced cysts, one arising from an intraocular lacrimal gland choristoma and one adjacent to a peripheral iris naevus.
Conclusions:
Most iris cysts of childhood are primary pigment epithelial cysts and require no treatment. However, the iris stromal cyst, usually recognised in infancy, is generally an aggressive lesion that requires treatment by aspiration or surgical excision.