Glaucoma drainage devices as a novel treatment option in the management of recurrent iris cysts

Abstract

Introduction

Epithelial inclusion cysts of the iris are a rare complication following ocular surgery or trauma and typically exhibit a more aggressive course than other types of iris cysts. Their management remains challenging due to their tendency for rapid growth, which can lead to obscuration of the visual axis, elevated intraocular pressure, corneal decompensation, and secondary glaucoma or uveitis. Particularly in pediatric and young adult patients, the high proliferative capacity of epithelial cells increases the risk of recurrence. Current treatment modalities, including Nd:YAG laser cyst disruption, sclerosing agent irrigation, and complete surgical excision, are associated with high recurrence rates.

Methods

In this retrospective case series we describe two patients with a recurrent iris cyst resulting from a trauma in childhood, and successfully managed with glaucoma drainage devices (Baerveldt tube and PAUL tube) to provide continuous cyst fluid drainage.

Results

In both cases, implantation of the drainage device effectively controlled the progression of the cyst and maintained its position outside the visual axis. The pediatric patient developed a scleral perforation at the surgical site one year postoperatively, following additional mechanical trauma from ocular rubbing; this complication was successfully managed with surgical repair, resulting in a favorable outcome. In the second case, the patient experienced a transient postoperative diplopia, which resolved spontaneously without further intervention.

Conclusion

These cases illustrate the potentially promising role of glaucoma drainage devices as a new treatment strategy for recurrent iris cysts, particularly after multiple prior resections or when conventional therapies have failed.