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Free-Floating Iris Cyst in Anterior Chamber
NOTES, CASES, INSTRUMENTS FREE-FLOATING IRIS CYST IN ANTERIOR CHAMBER REPORT OF A CASE FREDERICK D. GILLESPIE,
M.D.
Birmingham, Alabama
The origin of free-floating iris cysts in the anterior chamber of the eye, according to Ida Mann, is from the marginal sinus. The marginal sinus is a circular channel which remains open between the two layers of the rim of the optic cup until growth of the neural ectoderm is complete. This sinus be comes obliterated in man by approximation of its walls at about the end of fetal life. It is the last cavity of the primary optic vesicle to disappear. In many animals, it remains open throughout life and proliferates. It is normally seen in horses and other ungulates at the upper and lower borders of the pupils. The same cysts are seen on the pupillary borders in ectropion uvea, except that they are detached and are, therefore, cystic dilata tions of the marginal sinus. These small cystic and sometimes solid bodies are known as flocculi, granula, villositates, grape-seed bodies or corpora nigra.
They suggest an atavistic condition. Dymschitz reported a case in which a row of these flocculi surrounded the pupillary bor der, some of them being partially detached and hanging into the anterior chamber. Cysts on the pupillary border were re ported by Cowan in a mother and her three children, suggesting that the condition may be familial. Free cysts of the anterior chamber were first described by Businelli in 1867. Coats in 1912 reported a case and reviewed the litera ture. By 1928 when Clapp reported a case, 18 cases had been described. Since then sev eral cases have been reported, mostly in the European literature. CASE REPORT
Miss W. C, a 26-year-old white woman, was first seen on September 11, 1960. General medical history at that time showed that, in 1952, a meningioma of the occipital area had been removed and a tantalum plate put in the skull defect. Postoperatively she had had seizures which were controlled by anticonvulsants. Also, as a result of this tumor, she became deaf in the left ear and had a right homonymous hemianopia. In July, 1960, a diagnosis of acoustic neuroma on the right was made. The patient had an opera tion for the removal of this tumor which left the right ear deaf and the right side of the face para lyzed. This facial paralysis lead to exposure keratitis of the right cornea. Ophthalmologic examination. The pupils were normal bilaterally, regular and equal with normal reactivity. The rotations of both globes were full with no obvious ocular deviations. There was a marked facial paralysis on the right, with inabil ity to close the right lids. There was a coarse jerktype horizontal nystagmus. Slitlamp examination of the right cornea re vealed small punctate erosions of the corneal epi thelium. The iris and anterior segment of the right eye were normal. Slitlamp examination of the left eye revealed a chocolate-colored oval cystic and translucent body floating freely in the anterior chamber. This cyst appeared to measure about 1.5 to 2.0 mm. in diameter. Its surface was sprin kled with small dots of black iris pigment. It ap peared translucent and apparently was filled with fluid. The iris and anterior segment were normal. Both irises were normal after dilatation with 10percent Neosynephrine. Uncorrected visual acuity in the right eye was Fig. 1 (Gillespie). This photograph shows a free-floating cyst in the anterior chamber at the 20/25 ; in the left eye, 20/30. Intraocular pressure (Schi^tz) was 17 mm. Hg in each eye. 9-o'clock position. 804
NOTES, CASES, INSTRUMENTS Ophthalmoscopic examination showed normal fundi and discs. Visual fields confirmed a right homonymous hemianopia. This patient had normal serology, normal rou tine urinalysis, normal complete blood count and a hematocrit of 40 percent. An intermarginal lid adhesion was done on the right eye and a hypoglossal-facial anastomosis of both cranial nerves on the right was done later.
80S SUMMARY
A case of a free-floating iris cyst in the left eye of a 26-year-old white woman was presented together with the theories concern ing the origin of these cysts. University Hospital.
REFERENCES
1. Businelli: Corpuscle vesiculaire mobile dans la chambre antérieure. Ann. Ocul., 60:168, 1868. (Cited by Clapp, C. A. : Am. J. Ophth., 11:862, 1928.) 2. Clapp, C. A.: Free cyst in the anterior chamber. Am. J. Ophth., 11:862, 1928. 3. Coats, P.: Pigmented cyst lying free in the anterior chamber. Tr. Ophth. Soc. U. Kingdom, 32: 189, 1912. 4. Cowan, A.: Congenital and familial cysts and flocculi of the iris. Am. J. Ophth., 19:287-291 (Apr.) 1936. 5. Dymschitz, L. A.: Ein Fall von ungewöhnlich stark entwickelten Flocculi iridium. Arch. f. Ophth., 127:100, 1931. 6. Eicke, H.: Klin. Monatsbl. Augenh., 119:293, 1951. 7. Evans, W. H. : Free cyst in anterior chamber. Arch. Ophth., 15:822-825 (May) 1936. 8. Gasteiger, H.: Klin. Monatsbl. Augenh., 99:36, 1937. 9. : Free cyst in anterior chamber. Klin. Monatsbl. Augenh., 139:160 (Sept.) 1961. 10. Gerewitz, H. : Klin. Monatsbl. Augenh., 124:521, 1954. 11. Lewis, T. B.: Cyst of iris loose in anterior chamber. M. J. Australia, 2:454 (Oct.) 1932.
AN UNUSUAL CASE OF RETINAL DETACHMENT* SURGICAL REMOVAL O F A N O N M A G N E T I C I N T R A O C U L A R FOREIGN BODY WITH SUCCESSFUL RETINAL DETACHMENT SURGERY R A M O N CASTROVIEJO,
M.D.
AND L U I S ENRIQUE URIBE,
made a few days earlier by another ophthalmolo gist and surgical correction was advised. External examination resulted in negative find ings but ophthalmoscopic examination revealed an extensive retinal detachment nasally, with a horse shoe rent near the ora serrata at the 2-o'clock position. A highly réfringent rectangular mass, "' BW*atM.àt atun.
M.D.
New York There are few references in the ophthalmic literature to cases of combined surgery for the removal of an intraocular foreign body and the repair of a retinal detachment. T h e following case is of interest in view of the unusual etiologic factors involved. C A S E REPORT
A man, aged 46 years, was first seen in August, 1959. He complained that the vision in his right eye had been gradually diminishing for several weeks. A diagnosis of retinal detachment had been * From the Department of Ophthalmology, St. Vincent's Hospital, and New York University Post-Graduate Medical School.
Fig. 1 (Castroviejo and Uribe). Retinal detach ment, showing horseshoe rent and foreign body.
M.D.
Birmingham, Alabama
The origin of free-floating iris cysts in the anterior chamber of the eye, according to Ida Mann, is from the marginal sinus. The marginal sinus is a circular channel which remains open between the two layers of the rim of the optic cup until growth of the neural ectoderm is complete. This sinus be comes obliterated in man by approximation of its walls at about the end of fetal life. It is the last cavity of the primary optic vesicle to disappear. In many animals, it remains open throughout life and proliferates. It is normally seen in horses and other ungulates at the upper and lower borders of the pupils. The same cysts are seen on the pupillary borders in ectropion uvea, except that they are detached and are, therefore, cystic dilata tions of the marginal sinus. These small cystic and sometimes solid bodies are known as flocculi, granula, villositates, grape-seed bodies or corpora nigra.
They suggest an atavistic condition. Dymschitz reported a case in which a row of these flocculi surrounded the pupillary bor der, some of them being partially detached and hanging into the anterior chamber. Cysts on the pupillary border were re ported by Cowan in a mother and her three children, suggesting that the condition may be familial. Free cysts of the anterior chamber were first described by Businelli in 1867. Coats in 1912 reported a case and reviewed the litera ture. By 1928 when Clapp reported a case, 18 cases had been described. Since then sev eral cases have been reported, mostly in the European literature. CASE REPORT
Miss W. C, a 26-year-old white woman, was first seen on September 11, 1960. General medical history at that time showed that, in 1952, a meningioma of the occipital area had been removed and a tantalum plate put in the skull defect. Postoperatively she had had seizures which were controlled by anticonvulsants. Also, as a result of this tumor, she became deaf in the left ear and had a right homonymous hemianopia. In July, 1960, a diagnosis of acoustic neuroma on the right was made. The patient had an opera tion for the removal of this tumor which left the right ear deaf and the right side of the face para lyzed. This facial paralysis lead to exposure keratitis of the right cornea. Ophthalmologic examination. The pupils were normal bilaterally, regular and equal with normal reactivity. The rotations of both globes were full with no obvious ocular deviations. There was a marked facial paralysis on the right, with inabil ity to close the right lids. There was a coarse jerktype horizontal nystagmus. Slitlamp examination of the right cornea re vealed small punctate erosions of the corneal epi thelium. The iris and anterior segment of the right eye were normal. Slitlamp examination of the left eye revealed a chocolate-colored oval cystic and translucent body floating freely in the anterior chamber. This cyst appeared to measure about 1.5 to 2.0 mm. in diameter. Its surface was sprin kled with small dots of black iris pigment. It ap peared translucent and apparently was filled with fluid. The iris and anterior segment were normal. Both irises were normal after dilatation with 10percent Neosynephrine. Uncorrected visual acuity in the right eye was Fig. 1 (Gillespie). This photograph shows a free-floating cyst in the anterior chamber at the 20/25 ; in the left eye, 20/30. Intraocular pressure (Schi^tz) was 17 mm. Hg in each eye. 9-o'clock position. 804
NOTES, CASES, INSTRUMENTS Ophthalmoscopic examination showed normal fundi and discs. Visual fields confirmed a right homonymous hemianopia. This patient had normal serology, normal rou tine urinalysis, normal complete blood count and a hematocrit of 40 percent. An intermarginal lid adhesion was done on the right eye and a hypoglossal-facial anastomosis of both cranial nerves on the right was done later.
80S SUMMARY
A case of a free-floating iris cyst in the left eye of a 26-year-old white woman was presented together with the theories concern ing the origin of these cysts. University Hospital.
REFERENCES
1. Businelli: Corpuscle vesiculaire mobile dans la chambre antérieure. Ann. Ocul., 60:168, 1868. (Cited by Clapp, C. A. : Am. J. Ophth., 11:862, 1928.) 2. Clapp, C. A.: Free cyst in the anterior chamber. Am. J. Ophth., 11:862, 1928. 3. Coats, P.: Pigmented cyst lying free in the anterior chamber. Tr. Ophth. Soc. U. Kingdom, 32: 189, 1912. 4. Cowan, A.: Congenital and familial cysts and flocculi of the iris. Am. J. Ophth., 19:287-291 (Apr.) 1936. 5. Dymschitz, L. A.: Ein Fall von ungewöhnlich stark entwickelten Flocculi iridium. Arch. f. Ophth., 127:100, 1931. 6. Eicke, H.: Klin. Monatsbl. Augenh., 119:293, 1951. 7. Evans, W. H. : Free cyst in anterior chamber. Arch. Ophth., 15:822-825 (May) 1936. 8. Gasteiger, H.: Klin. Monatsbl. Augenh., 99:36, 1937. 9. : Free cyst in anterior chamber. Klin. Monatsbl. Augenh., 139:160 (Sept.) 1961. 10. Gerewitz, H. : Klin. Monatsbl. Augenh., 124:521, 1954. 11. Lewis, T. B.: Cyst of iris loose in anterior chamber. M. J. Australia, 2:454 (Oct.) 1932.
AN UNUSUAL CASE OF RETINAL DETACHMENT* SURGICAL REMOVAL O F A N O N M A G N E T I C I N T R A O C U L A R FOREIGN BODY WITH SUCCESSFUL RETINAL DETACHMENT SURGERY R A M O N CASTROVIEJO,
M.D.
AND L U I S ENRIQUE URIBE,
made a few days earlier by another ophthalmolo gist and surgical correction was advised. External examination resulted in negative find ings but ophthalmoscopic examination revealed an extensive retinal detachment nasally, with a horse shoe rent near the ora serrata at the 2-o'clock position. A highly réfringent rectangular mass, "' BW*atM.àt atun.
M.D.
New York There are few references in the ophthalmic literature to cases of combined surgery for the removal of an intraocular foreign body and the repair of a retinal detachment. T h e following case is of interest in view of the unusual etiologic factors involved. C A S E REPORT
A man, aged 46 years, was first seen in August, 1959. He complained that the vision in his right eye had been gradually diminishing for several weeks. A diagnosis of retinal detachment had been * From the Department of Ophthalmology, St. Vincent's Hospital, and New York University Post-Graduate Medical School.
Fig. 1 (Castroviejo and Uribe). Retinal detach ment, showing horseshoe rent and foreign body.