‘Ocular curiosities!’
Vitreous Cysts
Tansley, 1899 - irregular spherical cyst that showed lines of pigment on its surface
Congenital Cysts
Remnants of the hyaloid vascular system
Located at hyaloid canal & found in conjunction with Mittendorf's dot or
Bergmeister's papillae
Stable, do not progress and rarely interfere with vision
Non-pigmented pearl-gray cysts with a smooth surface, sessile or pedunculated
Located anterior to optic disc
Can be limited in movement due to vitreous strands attaching cyst to optic
disc
Acquired Cysts
Ocular trauma
Intraocular inflammation/infection/ uveitis eg. Intermediate Uveitis, Toxoplasmosis
Retinal diseases such as Retinitis pigmentosa, Choroidal atrophy, Retinoschisis, High myopia with uveal coloboma etc
Retinal detachment surgeries
Usually symptomatic -reduced vision
Types
Pigmented
From pigment epithelium of iris or ciliary body later become detached into the vitreous, Brown colour
Non-Pigmented
From hyaloidal vascular system
Translucent, mobile, yellow-gray
HPE
Congenital cysts are choristomas of primary hyaloidal system
Derived from pigment epithelium of iris or ciliary body
Contains immature melanosomes
Pathophysiology of Acquired Cysts
Trauma can cause damage to pigment epithelium of ciliary body and create pigment cysts
Other theories: Vitreous reaction to underlying retinal degeneration can causes cysts, Ciliary adenoma breaking into the vitreous, cystic growths that occur at site of coloboma that enter the vitreous
DD:
Pigmented cysts mimic pigmented ocular tumors such as malignant melanoma Nonpigmented cysts mimic parasitic cysts such as Cysticercosis, Echinococcus etc.
Ocular Investigations:
B Scan to look for scolex in case of cysticercosis
OCT - characterize the cyst
UBM - rule out anomalies of ciliary body or posterior iris
FFA - characterization of intra and extra cystic vascularisation
Management
Asymptomatic cysts
Observation and follow-up
Symptomatic cysts
Laser cystotomy by Argon laser/Nd:Yag laser
Pars plana vitrectomy with cyst excision
www.ophthalmobytes.com
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Link to article: https://eyewiki.aao.org/Vitreous_Cysts