Glaucoma associado a cistos de corpo ciliar e íris pseudoplateau: revisão sistemática da literatura

Schmalfuss, Tiago Ribeiro; Picetti, Egidio; Pakter, Helena Messinger

doi:10.5935/0004-2749.20180051

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REVIEW ARTICLE • Arq. Bras. Oftalmol. 81 (3) • May-Jun 2018 • https://doi.org/10.5935/0004-2749.20180051 copiar

Glaucoma associado a cistos de corpo ciliar e íris pseudoplateau: revisão sistemática da literatura

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

O diagnóstico de glaucoma de ângulo fechado secundário a cistos iridociliares é desafiador e não possui suporte da literatura compilada. Apresentamos um caso bilateral raro de glaucoma de ângulo fechado associado à íris pseudoplateau devido a cistos ciliares múltiplos e realizamos uma revisão sistemática da literatura de relatos de casos similares publicados entre novembro de 2006 e novembro de 2016. Apenas 19 relatos de casos apresentaram as modalidades de tratamento e na maioria deles foi necessário mais de uma abordagem terapêutica para controlar a pressão intra-ocular. Íris pseudoplateau atribuída a cistos iridociliários deve ser considerada no diagnóstico diferencial de pacientes com ângulos estreitos, particularmente aqueles com hipertensão ocular e glaucoma, em que o manejo é complexo. Além da go nioscopia, a biomicroscopia ultra-sônica é considerada o método conclusivo para o diagnóstico correto.

Descritores:
Glaucoma de ângulo fechado/etiologia; Cistos/com plicações; Corpo ciliar; Doenças da íris; Biomicroscopia ul tra-sônica; Diagnóstico diferencial; Íris pseudoplateau

Study	Year	Country	Case	Gender	Age	Eye	Cyst	Angle	Elevated IOP	Glauc.	Treatments	Outcomes
Schmalfuss et al.	2016	Brazil	1	F	54	RE	Multiple	Narrow/closed	Yes	Yes	Drug therapy without pilocarpine → iridotomy → drug therapy including pilocarpine	Controlled IOP
Schmalfuss et al.						LE	Multiple	Narrow/closed	Yes	Yes	Drug therapy without pilocarpine → iridotomy → drug therapy including pilocarpine	Controlled IOP
Berkani Kitouni et al.⁽⁹⁾9 Berkani Kitouni Z, Kitouni Y, Boukhecham D, Kherroubi R, Hartani D. [Plateau-like iris configuration secondary to multiple iridociliary cysts: case report of one family]. J Fr Ophtalmol. 2015;38(3):e41-2. French. ^* * only one eye involved in each case;	2015	Algeria	2	M	55	LE	Multiple	Narrow/closed	No	No	Iridotomy	Angle opened
				F	58	LE	Multiple	Narrow/closed	No	No	Iridotomy	Angle opened
Ispa-Callén et al.⁽¹⁰⁾10 Ispa-Callén MC, Lara-Medina J, Zarco-Tejada JM, López-Mondéjar E, Celis-Sánchez J, González-Del-Valle F. [Argon laser iridoplasty as treatment of plateau-like iris configuration secondary to multiple ciliary body cysts: long-term follow-up by ultrasound biomicroscopy]. Arch Soc Esp Oftalmol. 2009;84(11):569-72. Spanish.	2009	Spain	1	M	37	RE	Multiple	Narrow/closed	Yes	NR	Iridotomy → drug therapy without pilocarpine	Controlled IOP
						LE	Multiple	Narrow/closed	Yes	NR	Iridotomy → iridoplasty → drug therapy without pilocarpine	Controlled IOP
Ang et al.⁽¹¹⁾11 Ang GS, Bochmann F, Azuara-Blanco A. Argon laser peripheral iridoplasty for plateau iris associated with iridociliary cysts: a case report. Cases J. 2008;1(1):368.	2008	Switzerland	1	M	53	RE	Multiple	Narrow/closed	Yes	No	Iridotomy	Stable IOP
						LE	Multiple	Narrow/closed	Yes	No	Iridotomy → iridoplasty	Stable IOP
Vila-Arteaga et al.⁽¹²⁾12 Vila-Arteaga J, Díaz-Céspedes RA, Suriano MM. Plateau iris secondary to iridociliary cysts. Arch Soc Esp Oftalmol. 2015;90(11):542-5.	2015	Spain	1	F	63	RE	Multiple	Narrow/closed	Yes	Yes	Drug therapy without pilocarpine → iridotomy + iridoplasty → phacoemulsification	Controlled IOP
						LE	NR	Open	No	NR	NR	NR
Kaushik et al.⁽¹³⁾13 Kaushik S, Ichhpujani P, Kaur S, Singh Pandav S. Optic disk pit and iridociliary cyst precipitating angle-closure glaucoma. J Curr Glaucoma Pract. 2014;8(1):33-5.	2014	India	1	F	40	RE	Multiple	Narrow/closed	Yes	Yes	Drug therapy without pilocarpine → iridotomy → drug therapy without pilocarpine	Controlled IOP
						LE	NR	Narrow/closed	No	No	Iridotomy	Controlled IOP
Le Corre et al.⁽¹⁴⁾14 Le Corre A, Dot C, Feraoun M, Burelle X, Grasswill C, Perrenoud F, et al. [Plateau iris-like configuration resulting from numerous iridociliary cysts]. J Fr Ophtalmol. 2009;32(7):501-4. French.	2009	France	1	F	35	RE	Multiple	Narrow/closed	Yes	No	Iridotomy → drug therapy without pilocarpine	Controlled IOP
						LE	Multiple	Narrow/closed	No	No	NR	Controlled IOP
Baba et al.⁽¹⁵⁾15 Baba T, Hirooka K, Takagishi M, Sato S, Shiraga F. Plateau iris syndrome associated with cysts and nocturnal elevation of intraocular pressure. Can J Ophthalmol. 2008;43(6):725.	2008	Japan	1	F	38	RE	Multiple	Narrow/closed	Yes^† † nocturnal IOP elevation;	No	Iridotomy → drug therapy with pilocarpine	Controlled IOP
						LE	Multiple	Narrow/closed	Yes^† † nocturnal IOP elevation;	No	Iridotomy → drug therapy with pilocarpine	Controlled IOP
Pathak-Ray et al.⁽¹⁶⁾16 Pathak-Ray V, Ahmed II. Phaco-endocycloplasty: a novel technique for management of ring iridociliary cyst presenting as acute angle closure. Oman J Ophthalmol. 2016;9(1):63-5.	2016	Canada	1	F	63	RE	Single	Open	No	No	NR	NR
						LE	Ring	Narrow/closed	Yes	Yes	Drug therapy without pilocarpine → phacoemulsification + IOL + e ndocycloplasty 210°	Controlled IOP
Seki et al.⁽¹⁷⁾17 Seki M, Fukuchi T, Yoshino T, Ueda J, Hasebe H, Ueki S, et al. Secondary glaucoma associated with bilateral complete ring cysts of the ciliary body. J Glaucoma. 2014;23(7):477-81.	2014	Japan	1	F	33	RE	Ring	open	No	NR	NR	NR
						LE	Ring	Narrow/closed	Yes	Yes	Drug therapy (?) → lens extraction + implantation of IOL by VVPP → anterior capsulotomies + posterior synechiolysis	Controlled IOP
Choudhari et al.⁽¹⁸⁾18 Choudhari NS, Amula GM, Neog A. Inadvertent rupture of iridociliary cyst following transscleral Diode laser. Indian J Ophthalmol. 2013;61(3):124-6.	2013	India	1	M	56	RE	Ring	Narrow/closed	No	No	Ruptura do cisto com Nd:YAG laser iridotomy	Controlled IOP
						LE	Ring	Narrow/closed	Yes	Yes	Drug therapy (?) → contact transscleral Diode cyclophotocoagulation 180° below	Uncontrolled IOP
Mosaed et al.⁽¹⁹⁾19 Mosaed S, Jacobsen BH, Lin KY. Case report: imaging and treatment of ophthalmic manifestations in oculodentodigital dysplasia. BMC Ophthalmol. 2016;16:5.	2016	USA	1	F	6	RE	Multiple	Narrow/closed	Yes	Yes	Drug therapy without pilocarpine → Baerveldt Glaucoma Implant	Controlled IOP
						LE	Multiple	Narrow/closed	Yes	Yes	Drug therapy without pilocarpine → Baerveldt Glaucoma Implant	Controlled IOP
Curtin et al.⁽²⁰⁾20 Curtin J, Moloney G, Grigg J, Sharota Franzco D. Clinical characterization and proposed mechanism of juvenile glaucoma-a patient with a chromosome 4p deletion, Wolf-Hirschhorn Syndrome. Ophthalmic Genet. 2010;31(3):135-8.	2010	USA	1	M	22	RE	Multiple	Narrow/closed	Yes	Yes	Drug therapy without pilocarpine	Controlled IOP
						LE	Multiple	Narrow/closed	Yes	Yes	Drug therapy without pilocarpine	Controlled IOP
Gabriel et al.⁽²¹⁾21 Gabriel LA, Sachdeva R, Marcotty A, Rockwood EJ, Traboulsi EI. Oculodentodigital dysplasia: new ocular findings and a novel connexin 43 mutation. Arch Ophthalmol. 2011;129(6):781-4. ^ only one of the reported cases meets the criteria of this study;	2011	USA	1	F	2	RE	multiple	Narrow/closed	Yes	NR	drug therapy (?)	Controlled IOP
						LE	Multiple	Narrow/closed	Yes	NR	Drug therapy (?) → trabeculectomy + drug therapy (?) → pars plana lensectomy + vitrectomy + glaucoma shunt valve	Controlled IOP
Katsimpris et al.⁽²²⁾22 Katsimpris JM, Petropoulos IK, Sunaric-Mégevand G. Ultrasound biomicroscopy evaluation of angle closure in a patient with multiple and bilateral iridociliary cysts. Klin Monbl Augenheilkd. 2007; 224(4):324-7.	2007	Greece	1	F	82	RE	Multiple	Narrow/closed	Yes^†† †† dark room prone position or mydriasis increased IOP;	Yes	None	NR
						LE	Multiple	Narrow/closed	Yes^†† †† dark room prone position or mydriasis increased IOP;	Yes	None	NR
Aykan et al.⁽²³⁾23 Aykan U, Yildirim O. Combined laser treatment in a patient with pigment dispersion secondary to a large iris pigment epithelial cyst. Balkan Med J. 2012;29(3):339-42.	2012	Turkey	1	M	30	RE	Multiple	Open	Yes	No	Drug therapy without pilocarpine → Nd:YAG laser iridocystotomy + selective laser trabeculoplasty 180° below	Controlled IOP
						LE	Multiple	Open	Yes	No	Drug therapy without pilocarpine → Nd:YAG laser iridocystotomy + selective laser trabeculoplasty 180° below	Controlled IOP
Aydin et al.⁽²⁴⁾24 Aydin A, Kocak I, Sabahyildizi M. Auto-refractometry may assist in discovering asymptomatic iridociliary cysts. J Fr Ophtalmol. 2014; 37(5):e71-2.	2014	Turkey	1	M	53	RE	Multiple	Narrow at cyst	No	NR	NR	NR
						LE	NR	NR	No	NR	NR	NR
Baile et al.⁽²⁵⁾25 Baile R, Sahasrabuddhe M, Nadkarni S, Karira V, Kelkar J, Bhonde S. Bilateral multiple primary iridociliary cysts - A rare case report. Saudi J Ophthalmol. 2011;25(1):89-91.	2011	India	1	M	69	RE	Multiple	Narrow at cyst	Yes^††† ††† mydriasis increased IOP; (?) not detailed	NR	Drug therapy (?)	NR
						LE	Multiple	Open	Yes^††† ††† mydriasis increased IOP; (?) not detailed	NR	Drug therapy (?)	NR
Rivero et al.⁽²⁶⁾26 Rivero V, Aparicio MJ, Suárez-Leoz M, Fernández A. Vitreous hemorrhage secondary to iridociliary cyst. Arch Soc Esp Oftalmol. 2015;90(12):600-3.	2015	Spain	1	M	18	RE	NR	Open	No	No	NR	NR
						LE	Multiple	Open	No	No	NR	NR
Khan et al.⁽²⁷⁾27 Khan AO, Al-Assiri A. Lens coloboma associated with a ciliary body cyst. Ophthalmic Genet. 2007;28(4):208-9.	2007	USA	1	F	7	RE	Single	NR	NR	NR	NR	NR
						LE	NR	NR	NR	NR	NR	NR

Subclassification and number of eyes
						Glaucoma damage	4
				Pseudoplateau	14	Described only high IOP or IOP peaks	8
				Pseudoplateau	14	Described only high IOP or IOP peaks	8
						Normal IOP	2
		Narrow/closed angle	22			Glaucomatous damage	6
Multiple cysts	27			Pseudoplateau iris not described	8	Described only high IOP or IOP peaks	2
						Normal IOP	0
		Narrow/oclusivel angle on the cyst area	2	Glaucomatous damage			0
		Narrow/oclusivel angle on the cyst area	2	Elevated IOP when mydriasis			1
		Open angle	3	Glaucomatous damage			0
		Open angle	3	Ocular hypertension			2
Ring cyst	5	Narrow/closed angle	5	Glaucomatous damage			3
Single sector cyst	3			Not evaluable

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[1] Corresponding author: Tiago Schmalfuss. Rua Francisco Trein, 596 - Porto Alegre, RS - 91350-200 - Brazil. E-mail: tiagoschmalfuss@gmail.com