Relapse of the Ciliary Body with Glare Treated with a Neodymium-Doped Yttrium Aluminum Garnet Laser
This article presents a detailed case study of a patient who experienced a relapse of ciliary body cysts accompanied by glare, which was effectively treated using a neodymium-doped yttrium aluminum garnet (Nd:YAG) laser. The patient had initially been treated for the same condition three years prior, but the symptoms reappeared, necessitating further intervention. The treatment and its outcomes are discussed in depth, highlighting the use of advanced diagnostic tools and the efficacy of laser therapy in managing this condition.
The patient, who had previously undergone treatment for ciliary body cysts, reported recurrent glare in the left eye. Upon examination, the anterior segments of both eyes appeared normal, with visible iris holes created by the initial Nd:YAG laser treatment. An iris root bombe was observed at the 8 o’clock position in the left eye. Refractive measurements for the right eye were 1.0, –3.0/–1.75 at 170 degrees, resulting in a logMAR score of 0. For the left eye, the refractive measurement was 1.0, –4.75/–0.5 at 45 degrees, also resulting in a logMAR score of 0. The intraocular pressure in both eyes was measured at 16 mmHg.
The Optical Quality Analysis System (OQAS) was used to assess the visual quality of the patient’s eyes. The right eye exhibited an objective scattering index (OSI) of 0.5, a modulation transfer function (MTF) cutoff of 40.975, and a Strehl ratio of 0.183. In contrast, the left eye showed a significantly higher OSI of 2.6, a lower MTF cutoff of 18.603, and a reduced Strehl ratio of 0.128. These findings indicated a decline in the objective visual quality of the left eye, consistent with the patient’s complaint of glare.
Given the presence of multiple non-pigmented ciliary body cysts in both eyes, an immediate YAG laser cystectomy was performed through the iris incision at the 8 o’clock position in the left eye. The patient reported an immediate resolution of the glare following the procedure. Postoperative OQAS examination revealed an improvement in the left eye’s synchrony, with the OSI decreasing to 1.5, the MTF cutoff increasing to 23.411, and the Strehl ratio improving to 0.139.
One week after the surgery, the glare in the left eye had completely disappeared. Refractive measurements for the left eye remained unchanged at 1.0, –4.75/–0.5 at 45 degrees, with a logMAR score of 0. The intraocular pressure in the left eye was slightly elevated to 18 mmHg. OQAS examination showed further improvement in the left eye’s visual quality, with the OSI decreasing to 0.6, the MTF cutoff increasing to 44.539, and the Strehl ratio improving to 0.30. A new iris hole was observed at the 8:30 o’clock position, indicating the site of the recent laser intervention.
The findings from this case study support the theory that ciliary body cysts can significantly reduce visual quality, even in the absence of changes in visual acuity. The use of OQAS provided objective data to confirm the patient’s subjective experience of glare and the effectiveness of the laser treatment. The immediate resolution of symptoms and the improvement in OQAS metrics post-surgery underscore the efficacy of Nd:YAG laser cystectomy in managing this condition.
The article also discusses the potential for new cysts to develop after the removal of multiple cysts, highlighting the need for continued monitoring and possible repeat laser treatments. The authors emphasize the importance of using advanced diagnostic tools, such as OQAS, contrast sensitivity testing, and aberration examination, to comprehensively evaluate visual quality in patients with ciliary body cysts.
In conclusion, this case study demonstrates the successful management of a relapse of ciliary body cysts with glare using Nd:YAG laser treatment. The detailed analysis of preoperative and postoperative visual quality metrics provides valuable insights into the impact of ciliary cysts on visual function and the effectiveness of laser therapy. The findings underscore the need for a thorough diagnostic approach and the potential for repeat interventions in managing this clinical condition.
doi.org/10.1097/CM9.0000000000000546
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