Vitreous cysts can be congenital or acquired.
Congenital Cysts:
-Remnants of the hyaloid vascular system
-Located at hyaloid canal and found in conjunction with a Mittendorf's dot or Bergmeister's papillae.
-Stable, do not progress and rarely interfere with visual acuity.
-Non-pigmented pearl-gray cysts with a smooth surface, can be sessile or pedunculated.
-Located anterior to the optic disc.
-Some can be limited in movement due to vitreous strands attaching the cyst to the optic disc.
Acquired Cysts:
-Usually occur secondary to or associated with:
-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
-Symptomatic and associated with a reduction in visual acuity.
-Trauma can cause damage to the pigment epithelium of ciliary body and create pigment cysts.
PATHOLOGY:
-Congenital cysts are choristomas (normal tissues growing in abnormal location) of the primary hyaloidal system.
-Derived from the pigment epithelium of the iris or ciliary body.
-Contains immature melanosomes.
INVESTIGATIONS:
-B Scan Ultrasound to look for scolex in case of cysticercosis.
-OCT can also help characterize the cyst.
-UBM to rule out anomalies of ciliary body or posterior iris.
-Fluorescein angiography – assists in characterization of intra and extra cystic vascularization.
MANAGEMENT:
-Asymptomatic cysts: Observation and follow-up
Symptomatic cysts:
-Laser cystotomy by Argon laser or Nd:Yag laser.
-Pars plana vitrectomy with cyst excision.
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