Modified Three-port Approach for Absolute Alcohol-induced Sclerosis of Iris Stromal Cyst: A Case Report

Iris stromal cysts are rare, progressive ocular lesions that can cause visual impairment and amblyopia due to visual axis obstruction, corneal endothelial damage, uveitis, and secondary angle-closure glaucoma. Management is challenging due to recurrence, and surgical resection carries severe risks such as epithelial downgrowth, glaucoma, blindness, and potential loss of the eye. Absolute alcohol-induced sclerosis is a less invasive alternative; however, the literature on technique modifications remains limited. This case report describes the successful management of a primary iris stromal cyst with secondary ocular hypertension in a 9-year-old Filipino male using a modified three-port approach for absolute alcohol-induced sclerosis. The patient presented with a 4-month history of intermittent redness and pain in the left eye and was found to have elevated intraocular pressure (IOP) due to an iris stromal cyst. A modified three-port setup was prepared using a 30-gauge needle connected to a 3-way stopcock, a 3-mL syringe for aspiration, and an extension tube connected to a syringe containing absolute alcohol mixed with trypan blue dye. Although a 3-mL syringe was used for alcohol infusion, a 1-mL syringe may provide finer control. Postoperatively, transient corneal edema, mild anterior chamber inflammation, and steroid-induced intraocular pressure elevation were observed but resolved with medical management. At 18 months post-surgery, the patient remained asymptomatic, with a best-corrected visual acuity of 20/20, well-controlled IOP without medication, and no cyst recurrence. This case illustrates the effectiveness of a modified three-port approach in treating iris stromal cysts while preventing complications such as visual axis obstruction, glaucoma, and the need for more invasive surgery. This technique presents a practical and accessible option, especially in resource-limited settings. The paper also emphasizes the importance of meticulous technique and awareness of alcohol leakage, with key precautions outlined for safe application.