Relapse of the ciliary body with glare treated with a neodymium-doped yttrium aluminum garnet laser

To the Editor: We have reported that a patient with cysts of the ciliary body and glare was treated with a neodymium-doped yttrium aluminum garnet laser. The patient complained of recurrent glare in the left eye 3 years after initial treatment.^[1] The anterior segments of both eyes were unremarkable; iris holes created by the neodymium-doped yttrium aluminum garnet (Nd:YAG) laser were evident. An iris root bombe was apparent at 8 o’clock in the left eye. Right eye refraction was 1.0, –3.0/–1.75 × 170 → 0 (logMAR) and left eye refraction 1.0, –4.75/–0.5 × 45 → 0 (logMAR). The intraocular pressure of both eyes was 16 mmHg. Optical Quality Analysis System (OQAS; Visiometrics, Terrassa, Spain) examination revealed that the objective visual quality of the left eye had declined once more. The objective scattering index (OSI), modulation transfer function (MTF) cutoff, and Strehl ratio were 0.5, 40.975, and 0.183 for the right eye and 2.6, 18.603, and 0.128 for the left eye [Figure 1A]. As multiple, nonpigmented, ciliary body cysts were evident in both eyes, we performed immediate YAG laser cystectomy through the iris incision at 8 o’clock in the left eye. The patient reported that the glare resolved immediately. On OQAS examination, the left eye synchrony had improved, and the OSI, MTF cutoff, and Strehl ratio were 1.5, 23.411, and 0.139 [Figure 1B]. One week later, the left-eye glare had disappeared completely. The left eye refraction was 1.0, –4.75/–0.5 × 45 → 0 (logMAR) and the intraocular pressure 18 mmHg. The OSI, MTF cutoff and Strehl ratios of the left eye were 0.6, 44.539, and 0.30, respectively [Figure 1C]. A new iris hole was evident at the 8:30 o’clock position [Figure 1D].

Figure 1.

Optical Quality Analysis System data of the glare eye before (A), during (B), and 1 week after laser operation (C). A new iris hole was evident at the 8:30 o’clock position (black arrow), other iris holes were created 3 years ago (D). MTF: Modulation transfer function; OSI: Objective scattering index; VA: Visual acuity.

In our previous report, we theorized (based on the examination results) that ciliary cysts had caused the reported symptoms. The change after treatment was consistent with the change evident on objective OQAS examination. However, as we treated multiple cysts, the extent of intraocular inflammation was high; we thus lacked objective visual quality data. Here, the symptoms reappeared in the left eye. Newly discovered isolated lesions were appropriately treated; we also reported intraoperative examination data. The left eye symptoms resolved rapidly after surgery; a trend toward improvement was apparent before, during, and 1 week after surgery. The OSI decreased, and the MTF cutoff and Strehl ratio increased, confirming our reasoning.

Ciliary cysts can reduce visual quality. To evaluate the visual quality, we can use not only OQAS but also contrast sensitivity and an aberration examination. Interestingly, this patient had normal visual acuity. New cysts may appear after removal of multiple cysts. Repeat laser treatment was effective. This clinical condition deserves more attention.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms, and all patients have given their consent for images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and efforts will be made to conceal their identity but anonymity cannot be guaranteed.

Funding

This work was supported by a grant from the Science and Technology Commission of Shanghai (No. 17DZ2260100).

Conflicts of interest

None.