|Year : 2021 | Volume
| Issue : 3 | Page : 341-343
Nonpigmented immobile large vitreous cyst: A rare case report
Priyanka Gupta, Harsh V Garg
Department of Ophthalmology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
|Date of Submission||11-Aug-2020|
|Date of Acceptance||04-Sep-2020|
|Date of Web Publication||08-Dec-2021|
Dr. Priyanka Gupta
Department of Ophthalmology, Adesh Institute of Medical Sciences and Research, Bathinda - 151 001, Punjab
Source of Support: None, Conflict of Interest: None
Primary vitreous cysts are rare ocular manifestations. Often, they do not cause any visual disturbances. Vitreous cysts can be congenital or acquired. Here, we report the case of a 60-year-old male patient who presented to our outpatient department with a complaint of a bubble-like floater in his right eye which remained fixed despite movement of eyeballs. He had this visual disturbance for the past 20 years. The size and appearance of floater remained constant all these years. Aided visual acuity was 20/20 in both the eyes. Fundus examination showed the presence of a single transparent nonmobile cyst in the vitreous cavity of the right eye. Left eye fundus was normal. Right eye B-scan showed a nonmobile vitreous cyst abutting the optic nerve. The patient tested negative for Echinococcus and cysticercosis. As it was a primary vitreous cyst and the patient was asymptomatic, we decided to keep the patient under regular follow-up.
Keywords: Floater, immobile cyst, vitreous cyst
|How to cite this article:|
Gupta P, Garg HV. Nonpigmented immobile large vitreous cyst: A rare case report. Kerala J Ophthalmol 2021;33:341-3
| Introduction|| |
Vitreous cysts are rare ocular manifestations. Patients having vitreous cysts are usually asymptomatic, but few patients can present with a bubble-like floater in front of the eyes. Visual acuity is not affected generally. Vitreous cysts are diagnosed on routine fundus examination. As they are mostly asymptomatic, management should be conservative. Invasive intervention is rarely required. Seldom, small fixed vitreous cysts have been reported in the past, although a large-sized fixed idiopathic vitreous cyst still remains a unique clinical finding. Here, we present a case of fixed, transparent vitreous cyst which generates curiosity given its large size.
| Case Report|| |
A 60-year-old male patient presented to our outpatient department with a history of a bubble-like floater in his right eye for the past 20 years. There was no history of any systemic disorder, trauma, or infection in the eye. Vision was 6/6 in both the eyes. Intraocular pressure of the right and left eyes was 16 and 12 mmHg, respectively, measured with noncontact tonometer. The anterior segment of both the eyes was normal, with no signs of inflammation. Indirect ophthalmoscopy and posterior segment biomicroscopy were performed after dilation which showed a vitreous cyst in his right eye which was not changing its position with ocular movements. Fundus was normal in the left eye. No degeneration was detected in the peripheral retina of both the eyes. Fundus photograph showed a well-demarcated large vitreous cyst with a remarkable absence of any pigmentation. The surface wall of the cyst was smooth and transparent, with underlying retina clearly visible [Figure 1]. Right eye B-scan ultrasonography showed a well-defined cystic lesion measuring approximately 10.8 mm × 11.3 mm in the posterior chamber of the right eye [Figure 2]. The cyst was adherent to the posterior wall with no positional change on eyeball movement. There was no vascular uptake on colour doppler flow imaging (CDFI). Serology was negative for Echinococcus and cysticercosis. There was no eosinophilia on peripheral blood smear. Stool examination was negative for parasite ova. Based on these findings, the patient was diagnosed as idiopathic nonpigmented fixed vitreous cyst. As the patient had few symptoms, no active intervention was done. The patient is on routine follow-up.
|Figure 1: Large fixed vitreous cyst with underlying retina clearly visible|
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|Figure 2: B-scan ultrasound showing a fixed vitreous cyst measuring 10.8 mm × 11.3 mm|
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| Discussion|| |
Tansley was the first person to describe free-floating vitreous cyst in 1899. Vitreous cysts can be classified into congenital or acquired. The congenital vitreous cysts further can be pigmented or nonpigmented. The former are believed to arise from the iris or ciliary body pigment epithelium. On the contrary, the nonpigmented vitreous cysts are the remnants of the primary hyaloid vascular system such as Bergmeister's papilla and Mittendorf's dot.
Acquired vitreous cysts are mostly associated with inflammatory conditions such as toxoplasmosis, Echinococcus, and cysticercosis. They can also be associated with Intermediate uveitis, degenerative diseases of the retina or choroid, retinal detachment surgeries, and ocular trauma. Trauma as a cause of vitreous cyst formation was first described by Awan in 1975. Ocular trauma may cause the dislocation of already formed cyst.
An electron microscopic study of vitreous cyst by Orellana et al. hypothesized the origin of cyst to be pigment epithelium.
Nork and Millecchia reported immature melanosomes in pigmented epithelium tissue on histopathological examination of vitreous cyst and put forth the hypothesis that it is choristoma of the primary hyaloid system.
Most of the idiopathic vitreous cysts which were reported earlier are pigmented and free floating in vitreous. However, in our case, an adult presented with a large vitreous cyst which was nonpigmented and fixed posteriorly. Such large, nontraumatic, idiopathic cysts have rarely been reported. Despite the size, the patient can be managed conservatively as the patient is asymptomatic. Intervention in the form of laser cystotomy or vitrectomy may be indicated if the patient develops any symptoms.
| Conclusion|| |
Primary fixed vitreous cyst is a rare entity. Our case documents a possibility of a large nonmobile vitreous cyst which can be kept under observation if the patient is asymptomatic.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
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Awan KJ. Multiple free floating vitreous cysts with congenital nystagmus and esotropia. J Pediatr Ophthalmol 1975;12:49-53.
Orellana J, O'Malley RE, McPherson AR, Font RL. Pigmented free-floating vitreous cysts in two young adults. Electron microscopic observations. Ophthalmology 1985;92:297-302.
Nork TM, Millecchia LL. Treatment and histopathology of a congenital vitreous cyst. Ophthalmology 1998;105:825-30.
[Figure 1], [Figure 2]