Bilateral iris cysts in an infant with retinopathy of prematurity

An 8-week-old premature infant, a diagnosed case of aggressive posterior retinopathy of prematurity (ROP), was brought to the ophthalmologist for routine follow-up post-laser treatment. Undilated anterior segment examination was normal. On pupillary dilation, multiple, dark brown, rounded protrusions (arrows) could be visualized behind the pupillary margin in both eyes [Fig. 1]. Posterior segment showed a well-lasered regressing ROP with no sequalae. A diagnosis of bilateral mid-zonal iris pigment epithelial (IPE) cysts was made. These cysts are caused by separation of the anterior and posterior pigment epithelium of the iris with accumulation of fluid between them.[1] Pupillary dilation everts these cysts on to the pupillary margin and can mimic a ciliary body malignant melanoma.[2] IPE cysts mostly remain asymptomatic and can simply be observed.[3]

Figure 1.

(a and b) Anterior segment of the right and left eye respectively, showing multiple, dark brown, rounded protrusions (arrows) emerging from behind the pupillary margin after pupillary dilation suggestive of mid-zonal iris pigment epithelial cysts

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