Turkiye Klinikleri Journal of Ophthalmology

.: ORIGINAL RESEARCH
İris Pigment Epitel Kistlerinde Klinik ve Ultrason Biyomikroskopik Bulgular
CLINICAL AND ULTRASONIC BIOMICROSCOPIC FINDINGS ıN ıRIS PIGMENT EPITHELIAL CYSTS
Kaan GÜNDÜZa, Banu HOŞALa, Güler ZİLELİOĞLUa, Sibel DEMİRELa
aGöz Hastalıkları AD, Ankara Üniversitesi Tıp Fakültesi, ANKARA
Turkiye Klinikleri J Ophthalmol. 2006;15(1):6-11
Article Language: TR
ÖZET
Amaç: İris pigment epitel (İPE) kistlerinin klinik bulguları, ultrason biyomikroskopik (UBM) görüntüleme sonuçları ve izlem sonuçlarını sunmak Gereç Yöntemler: İPE kisti tespit edilen 12 olguda görme keskinliği ölçüldü; ön segment biyomikroskopisi, göz içi basınç ölçümü, gonyoskopi, pupil dilatasyonu, ve fundus muayenesi uygulandı. Etkilenen gözlere transillüminasyon ve UBM yapıldı. Bulgular: Olguların yaş ortalaması 36.3 (18-64) yaş idi. Altı olgu kadın, 6 olgu erkekti. Tüm olgular, kliğimize iris melanomu ön tanısıyla refere edilmişlerdi. Görme keskinliği 2 olguda başka nedenlere bağlı azalmış olarak bulundu. On bir olguda kistin bulunduğu bölgede iriste lokalize kabarıklık tespit edildi; 1 olguda kist ön kamarada idi. Disloke İPE kisti dışındaki 11 gözün dokuzunda kist alt temporal, bir gözde alt nazal, bir gözde ise alt nazal ve temporal yerleşimliydi. Pupil dilatasyonu sonrasında 11 gözün 8 (%72.7)'inde İPE kisti görülebildi. Transillüminasyonda, İPE kistlerinin ışık blokajı yapmadıkları tespit edildi. Klinik ve UBM bulgularına göre, İPE kistleri 9 gözde periferik (iridosiliyer) tipte, 2 gözde midzonal tipte, 1 gözde ise ön kamara yerleşimli disloke tipte idi. Altı olguda UBM ile ölçülen en büyük ortalama kist çapı 1.8 mm (0.9-2.3 mm) idi. Üç olgudaki klinik veriler de dikkate alındığında, toplam 9 olgudaki en büyük ortalama kist çapı 3.9 mm (0.9-20 mm) olarak bulundu. Periferik İPE kisti olan 2 olguda, UBM ile, kistin bilobüle olduğu saptandı. Ortalama 21.9 ay (3-60 ay) izlemde, tüm periferik ve midzonal İPE kistleri stasyoner olarak kaldı ve herhangi bir komplikasyonla karşılaşılmadı. Ön kamarada serbest dolaşan kist yaklaşık 36 aylık izlemde spontan olarak kollabe oldu. Sonuç: İPE kistleri, iriste kabarıklık şeklinde ortaya çıkar ve iris melanomu ile karışabilir. Tanıda pupil dilatasyonu ile kistin görülmesi, transillüminasyon ve UBM önemli yer tutmaktadır. İPE genellikle asemptomatik olarak seyrettikleri için tedavi gerektirmezler.

Anahtar Kelimeler: İris pigment epitel kisti, transillüminasyon, ultrason biyomikroskopi, iris melanomu
ABSTRACT
Objective: To report the clinical, ultrasonic biomicroscopic imaging findings and follow-up data on iris pigment epithelial (IPE) cysts. Material and Methods: Twelve patients with IPE cysts underwent complete ocular examination including visual acuity determination, intraocular pressure measurement, anterior segment biomicroscopy, gonioscopy, pupillary dilation, funduscopy. Transillumination and UBM examination were also performed. Results: The mean age of the patients was 36.3 years, ranging from 18 to 64 years. Six patients were women and 6 were men. All patients were referred with the diagnosis of iris melanoma. Visual acuity was found to be decreased in 2 cases due to reasons other than the IPE cyst. In 11 eyes, there was localized bulging of the iris in the region of the IPE cyst and in one eye the IPE cyst was freely floating in the anterior chamber. Except for the eye with dislocated IPE cyst, the IPE cyst was located inferotemporally in 9 eyes, inferonasally in 1 eye, and inferior nasal-temporally in 1 eye. The cyst wall was visible in 8 of these 11 (72.7%) eyes. The IPE cysts were found to transilluminate and did not cause blockage of transmitted light. Based on the clinical and UBM features, the IPE cyst was of the peripheral (iridociliary) type in 9 eyes, midzonal type in 2 eyes, and dislocated type in 1 eye. The mean largest cyst diameter measured with UBM in 6 cases was 1.8 mm, ranging from 0.9 mm to 2.3 mm. Considering the clinical findings in 3 cases, the mean largest cyst diameter measured on clinical and UBM grounds was 3.9 mm, ranging from 0.9 mm ile 20 mm. In 2 eyes with peripheral cysts, the IPE cyst was bilobed on UBM examination. At a mean follow-up of 21.9 months (3-60 months), peripheral and midzonal IPE cysts remained stationary and no ocular complication was encountered. The dislocated IPE cyst spontaneously deflated after 36 months of followup. Conclusion: IPE cysts cause bulging of the iris and may cause diagnostic confusion with iris melanoma. Pupillary dilation and observation of the cyst, transillumination, and UBM are important in diagnosis. IPE cysts do not require treatment since they are usually asymptomatic.

Keywords: Iris pigment epithelial cyst, ultrasound biomicroscopy, transillumination, iris melanoma

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