|Year : 2016 | Volume
| Issue : 1 | Page : 47-49
Free-floating vitreous cyst
Hoda S Mohamed, Wafaa A Madbouly
Department of Ophthalmology, Faculty of Medicine, Alazhar University, Cairo, Egypt
|Date of Submission||19-Aug-2015|
|Date of Acceptance||27-Nov-2015|
|Date of Web Publication||21-Oct-2016|
Hoda S Mohamed
Department of Ophthalmology, Faculty of Medicine, Alazhar University, 189 Alnozha, Cairo
Source of Support: None, Conflict of Interest: None
Free-floating intraocular cysts can be divided into those occurring in the anterior chamber, those occurring in the retrolental space, and those occurring in the vitreous cavity. The origin of vitreous cysts may be associated with remnants of the hyaloid system (congenital), or can result from trauma or ocular disease. The aim of this study was to assess the impact of free-floating vitreous cyst on the macula using optical coherence tomography, ultrasonography, and fluorescein angiography. A 58-year-old female patient presented for eye examination complaining of annoying movable floaters with glare and difficultly in close works. Ophthalmoscopic examination through the dilated fundus revealed posterior vitreous detachment, unremarkable peripheral retinal degenerations with no abnormalities at the optic disc, the macula or papillomacular bundle, and the anterior segment and pupillary reaction were free. This case report represents a case of free-floating vitreous cyst that has been advised for follow-up until it becomes visually significant, requiring interference either with argon laser cystotomy or aspiration through pars plana vitrectomy.
Keywords: B-scan ultrasonography, fluorescein angiography, optical coherence tomography, vitreous cyst, vitreous floaters
|How to cite this article:|
Mohamed HS, Madbouly WA. Free-floating vitreous cyst. J Egypt Ophthalmol Soc 2016;109:47-9
| Introduction|| |
Free-floating intraocular cysts can be divided into those occurring in the anterior chamber, those occurring in the retrolental space, and those occurring in the vitreous cavity . The origin of vitreous cysts may be associated with remnants of the hyaloid system (congenital), or can result from trauma or ocular disease. Bilateral cases have been reported in cases with retinitis pigmentosa and in patients after retinal detachment surgeries ,.
On electron microscopic study of free-floating vitreous cyst, Orellana et al.  suggested that the cysts had originated from the displacement of pigmented ciliary epithelium from the region of the pars plana, possibly after blunt trauma. Patients with symptomatic vitreous floaters are indicated for surgery . Neodymium YAG laser vitreolysis has been used to treat vitreous floaters ,, but is less efficacious than vitrectomy and symptoms resolved completely in 93% of eyes ,.
We report a case of free-floating vitreous cyst that eventually led to much disturbance in visual functions and was annoying to the patient.
| Case report|| |
A 58-year-old female patient presented for eye examination complaining of annoying movable floaters with glare and difficulty in close works.
Examination showed that unaided visual acuity of the right eye was 3/60, and that of the left was 6/36 with anisometropia and corneal astigmatism; refraction of the right eye was –12/–7 ↓70 and that of the left eye was ↓–7/–5 ↓110.
Ophthalmic examination revealed unremarkable changes in the left eye, whereas right eye showed large cystic mass in the vitreous cavity. The free floating cyst appears with clear outer borders with significant vitreous liquifaction around it and is filled with fluid like substance, and measures 5 mm in diameter by B scan and sinks down in vitreous cavity at resting position inferonasal to the visual axis.
Ophthalmoscope examination through the dilated fundus revealed posterior vitreous detachment, unremarkable peripheral retinal degenerations with no abnormalities at the optic disc, the macula, or papillomacular bundle, and the anterior segment and pupillary reaction were free.
The patient was examined at the retinal clinic with a panfundoscopic lens, which revealed that this cyst was due to lacunae of vitreous spaces, with mild pigmentation and freely mobile walls with no traction on the retina or the vitreous base and not obscuring vision.
B-scan ultrasound confirmed the cystic nature ([Figure 1]).
|Figure 1: B-scan ultrasound revealing the cyst crossing the visual axis.|
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Optical coherence tomography macula and optic disc scans revealed no vitreoretinal traction ([Figure 2]).
|Figure 2: Optical coherence tomography scan of the macula revealing no vitreomacular traction.|
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Fundus photo was taken with difficulty and revealed shadowing of the cystic cavity on the underlying retina with myopic posterior pole ([Figure 3]).
|Figure 3: Fundus photo revealing shadowing of the cyst on the retinal structure inferiorly.|
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The patient was advised to neglect it and that with time she will get accustomed to its shadow on the retina. However, the patient was advised that laser cystic capsulotomy may be recommended if the problem persists and she is unable to tolerate it.
| Discussion|| |
Free-floating vitreous cysts may appear oval, spherical, single, or multilobed, and their walls may be transparent or slightly pigmented, with a glistening effect that catches light at ophthalmoscopic examination. Their sizes may vary from 0.2 to 15 mm as measured on B-scan ultrasonography .
These cysts usually do not significantly affect the vision unless crossing the visual axis and usually does not require treatment as they mostly settle inferiorly .
Orellana et al.  removed a vitreous cyst through the pars plana approach, aspirating it with a 20-G needle, which allows the cyst to collapse through the needle.
Awan  suggested disturbing the cyst with argon laser photocystotomy so that any debris may settle and produce no disturbance.
Kennelly et al.  reported the case of a 37-year-old White female complaining of a ring floater in the central visual field of her left eye. The benign nature of the cyst was explained to her and the risks and benefits of vitrectomy were explained. Her symptoms had fully resolved after conservative treatment for 3 months as the cyst moved inferiorly .
Toklu et al.  reported the case of a 50-year-old man complaining of floaters in his right eye. The patient was followed up with conservative treatment .
| Conclusion|| |
This case report represents a case of free-floating vitreous cyst that is left for follow-up unless it becomes visually significant, requiring interference either with argon laser cystotomy or aspiration through pars plana vitrectomy.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Jones WL. Free-floating vitreous cyst. Optom Vis Sci 1998; 75:171–173.
Duke-Elder S. Kimpton H. System of ophthalmology. Normal and abnormal development: congenital deformities. 1st ed.London: Mosby:St Louis; 1964. 763.
Bayraktar Z, Kapran Z, Ozdogan S. Pigmented congenital vitreous cyst. Eur J Ophthalmol 2004; 14:156–158.
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.
Wagle AM, Lim WY, Yap TP, Neelam K, Au Eong KG. Utility values associated with vitreous floaters. Am J Ophthalmol 2011; 152:60–65.e1.
Toczołowski J, Katski W. Use of Nd:YAG laser in treatment of vitreous floaters. Klin Oczna 1998; 100:155–157.
Tsai WF, Chen YC, Su CY. Treatment of vitreous floaters with neodymium YAG laser. Br J Ophthalmol 1993; 77:485–488.
Delaney YM, Oyinloye A, Benjamin L. Nd:YAG vitreolysis and pars plana vitrectomy: surgical treatment for vitreous floaters. Eye (Lond) 2002; 16:21–26.
Tan HS, Mura M, Lesnik Oberstein SY, Bijl HM. Safety of vitrectomy for floaters. Am J Ophthalmol 2011; 151:995–998.
Awan KJ. Biomicroscopy and argon laser photocystotomy of free-floating vitreous cysts. Ophthalmology 1985; 92:1710–1711.
Kennelly KP, Morgan JP, Keegan DJ, Connell PP. Objective assessment of symptomatic vitreous floaters using optical coherence tomography: a case report. BMC Ophthalmol 2015; 15:22–122.
Toklu Y, Raza S, Cakmak HB, Cagil N. Free-floating vitreous cyst in an adult male. Korean J Ophthalmol 2013; 27:463–465.
[Figure 1], [Figure 2], [Figure 3]