Clinical observations of iridociliary cysts and their changes after implantable collamer lens implantation in myopic patients

AIM:To observe the characteristics of iridociliary cysts in myopic patients and evaluate the influences on the position and safety of implantable collamer lens(ICL)after surgery.METHODS:Totally 270 eyes of 135 patients who underwent ICL surgery for the corrections of myopia were included in this study.Preoperative and postoperative morphology of iridociliary cysts were observed in ultrasonic biomicroscopy(UBM)image.RESULTS:A total of 138 iridociliary cysts were found in 88 eyes of 50 patients among 270 eyes of 135 patients before surgery(37%).Twenty-five patients had cysts in one eye(50%)and 25 had cysts in both eyes(50%).The prevalence of iridociliary cysts was negatively correlated with age,but no gender difference(P>0.05).The incidence of iridociliary cysts was much less in eyes with myopia greater than-9.00 D(P<0.05).The diameter of the largest cyst was 1.96 mm and the smallest cyst was 0.24 mm,with a majority within the range of 0.5 to 1.0 mm.Most of the cysts were located in the inferior temporal quadrant.One year after ICL implantation,51 iridociliary cysts(37%)remained unchanged,47 cysts(34%)decreased in size,and 40 cysts(29%)disappeared.Most of cysts that changed after surgery were smaller than 1.0 mm(P<0.05)and located in the nasal and temporal sides around the haptics of implantable lens.All the ICL were in their original position.CONCLUSION:Iridociliary cysts are commonly seen in myopic eyes.The cysts have no impact on the safety of ICL surgery.Some cysts may decrease in size or disappear after ICL implantation.

Management strategies in malignant glaucoma secondary to antiglaucoma surgery

AIM：To assess the outcomes of various interventions for malignant glaucoma（MG）.·M ETHODS：A retrospective,comparative analysis of case series were performed on 38 eyes of 35 MG patients treated in Aier Eye Hospital of Wuhan between Jan.2009and Dec.2012.Numerous treatments were administered including medical therapy,neodymium：yttriumaluminium-garnet（Nd：YAG）laser posterior capsulotomy and hyaloidotomy as well as 3 surgical options.The characteristic,treatment option and outcome of MG in every individual patient were reviewed and analyzed among all patients who were followed up for an average of 27.1±9.1mo.·RESULTS：Four eyes of 3 patients achieved complete resolution with medical therapy.Nd：YAG laser posterior capsulotomy and hyaloidotomy were performed on 2 eyes,both of which achieved resolution after initial intervention.Thirty-two eyes were given surgical treatments with anterior vitrectomy-reformation of anterior chamber in13 eyes,phacoemulsification-intraocular lens implantation in 10 eyes and phacoemulsification-intraocular lens implantation-anterior vitrectomy in 9 eyes.Resolution of MG was seen in almost all patients.The mean intraocular pressure decreased from 41.87±9.44 mm Hg at presentation to 15.84±3.73 mm Hg at the last visit.The mean anterior chamber depth improved from 0.28±0.27 mm to 2.28±0.19 mm.Twenty eyes with preoperative visual acuity better than counting figure/50 cm had various visual improvements.Complications occurred in 3 eyes of 3 patients including bleeding at the entry site of vitrectomy into vitreous cavity,corneal endothelial decompensation and allergic to atropine respectively.·CONCLUSION：MG occurs as a result of multiple mechanisms involved simultaneously or sequentially.Medical therapy is advocated as the initial treatment,laser therapy is beneficial in pseudophakic eyes,and different surgical regimen is recommended based on different pathogenesis of MG when non-response occurs to nonsurgical management.MG can be managed successfully by appropriate and timely interventions with good visual outcome.