Vitreous Cyst!



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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