1. Ultrasound Biomicroscopy Diagnosis of Benign Iris Cysts in Patient Presenting for Implantation of Copolymer Phakic IOL Muhammad Aman-Ullah MD Howard V. Gimbel MD Gimbel Eye Centre Calgary AB Canada ASCRS San Diego 2011 Authors Have No Financial Interest

2. UBM of Iris Cysts in ICL Surgery Purpose To report a case with a peripheral iris cyst diagnosed incidentally during preoperative testing for STAAR Visian posterior chamber toric implantable copolymer phakic IOL

3. Method Routine ultrasound biomicroscopy (UBM Sonomed) of the sulcus for determination of toric ICL (TICL) length revealed a peripheral iris cyst in each eye that was otherwise undetected during slit lamp examination UBM of Iris Cysts in ICL Surgery

4. OD/OS -11.25 –1.00 X 015 20/15-2 Pupil size –Mesopic 2.89/3.09 mm –Scotopic 5.22/4.64 mm ACD 3.22 mm OU WTW 11.6 mm OU Pachymetry 506/513 um Results 32 year-old male Presented for TICL Implantation OU Nov 2009 UBM of Iris Cysts in ICL Surgery

5. High frequency UBM exam (Sonomed VuMaxII) – showed bilateral peripheral iris (iridociliary) cysts junction between the iris and ciliary body Cyst in OD is unilateral at 9 o’clock meridian –Round, 1.03 mm in diameter Cyst in OS is unilateral at 2:30 o’clock –Ovoid, 1.22 x 1.54 mm UBM OU reveals internal echolucency and thin walls typical of neuroepithelial cysts –UBM STS OD 11.41 mm OS 11.53 mm Results UBM of Iris Cysts in ICL Surgery

6. Pre-op cyst OS Pre-op cyst OD Results UBM of Iris Cysts in ICL Surgery Pre-op cyst OS

7. Results UBM of Iris Cysts in ICL Surgery Post YAG attempted drainage OS One day pre-op

8. Open angle Results UBM of Iris Cysts in ICL Surgery 7 wks post-op UCVA 20/20 OU IOP 12 OU TICL temporal haptic in sulcus OD TICL temporal haptic pressing into the cyst OS Open angle

9. TICL temporal haptic has settled posterior with no pressure on the cyst OS TICL temporal haptic remains stable in the sulcus OD Results 7 mos post-op UCVA 20/15; 20/20 IOP 15/18 UBM of Iris Cysts in ICL Surgery

10. Results UBM of Iris Cysts in ICL Surgery 2.25 yrs post-op UCVA 20/15; 20/20 IOP 18 OU TICL temporal haptic pressing into the cyst OS TICL temporal haptic remains stable in the sulcus OD TICL temporal haptic pressing into the cyst OS

11. Discussion This case report demonstrates the feasibility of implanting an ICL with peripheral Iris cysts. No other reports of such surgeries were found to compare. UBM systems are suitable for imaging of virtually all anterior segment anatomy and pathology, including the cornea, iridocorneal angle, anterior chamber, iris, ciliary body and lens. UBM is thus applicable for diagnostic imaging of corneal diseases, glaucoma, cysts and tumors as well as IOL implants. UBM of Iris Cysts in ICL Surgery

12. Conclusion UBM is successful in imaging and diagnosing iridocorneal cysts. ICL implantation is possible and remains safe even in the presence of peripheral iris cysts. In our case report, UBM exam shows the TICLs remain stable in position with long term follow up of more than two years. UBM of Iris Cysts in ICL Surgery