Concurrent Descemet Stripping Only With Excision of Iris Pigment Epithelial Cysts

To describe a case of bilateral large iris pigment epithelial (IPE) cysts causing corneal endothelial dysfunction that was successfully managed with a surgical cyst excision combined with Descemet stripping only (DSO) procedure followed by postoperative rho kinase inhibitor (ROCK-I) administration.

Case report.

A 27-year-old woman presented with bilateral large IPE cysts adhering to the corneal endothelium, causing endothelial dysfunction with overlying corneal edema. Ultrasound biomicroscopy of both eyes revealed multiple thick-walled cysts, with points of adhesion to the pupillary margin, occupying the central part of the anterior chamber and adhering anteriorly to the corneal endothelium. Baseline pachymetry measurements were 631 μm in the right eye and 980 μm in the left. Following surgical excision, cystic lesions are removed from the posterior aspect of the cornea, in a similar fashion to the DSO technique. Pathology confirmed the presence of iris epithelium and Descemet membrane without evidence of malignancy. Topical netarsudil 0.02% was administered postoperatively, resulting in significant improvement in vision, complete resolution of corneal edema, reduction in corneal pachymetry, and a significant increase in central endothelial cell count at 6 months postoperatively, without recurrence of cysts.

DSO combined with cyst excision, followed by topical ROCK-I administration, is a viable approach for the management of corneal decompensation associated with IPE cysts that are adherent to the endothelium. We herein demonstrate complete clearance of corneal edema and excellent visual outcomes without cyst recurrence, potentially avoiding the need for endothelial keratoplasty.