Hemorrhagic retinal cysts revealing astrocytic glial hyperplasia 20 years after vitrectomy for post-traumatic retinal detachment

Abstract

Purpose

Pre-retinal cysts are rare and poorly characterized clinical entities. Unlike intraretinal cysts commonly associated with macular diseases, pre-retinal cysts have distinct etiologies and require specific diagnostic and therapeutic strategies. Proper differentiation and comprehension of glial retinal homeostasis are key to appropriate management.

Case presentation

We report the case of a 65-year-old man with a history of post-traumatic retinal detachment treated surgically, and a subluxated intraocular lens (IOL) replaced with an iris-clipped lens for UGH syndrome. The patient experienced multiple episodes of spontaneously resolving vitreous hemorrhage. Inter-episode fundus examination revealed three large pre-retinal cysts in the superotemporal quadrant, located along the edges of the reattached retina, associated with intermittent intracystic hemorrhages. Management involved surgical excision, coagulation, and en bloc excision of the cysts. Pathologic examination of the cyst showed a glial proliferation, with a pilocytic astrocytic morphology, consistent with a benign proliferation.

Discussion

After an in-depth etiological and pathological investigation, tumoral, infectious, and congenital causes were ruled out. This case represents a unique manifestation of multiple pre-retinal cystic astrocytic glial proliferations, complicated by recurrent intra-cystic and vitreous hemorrhages, successfully managed with surgical en-bloc excision.