Iris Stromal Cyst Aspiration and Irrigation with Absolute Alcohol

In this clinical video, Drs. Mohsin Ali, Wenlan Zhang, and Miguel Materin manage a case of an iris stromal cyst by absolute alcohol irrigation. The 13-year-old male had a cyst measuring approximately 5 to 6 mm in diameter and 3 mm in height. The cyst had enlarged over the preceding 2 months and, at presentation, was obstructing the patient’s central visual axis, causing his vision to decrease to 20/50. The surgical technique shown in the video involves aspiration of the cyst contents along with irrigation of the cyst cavity with absolute alcohol. While other options were discussed, including aspiration alone and excision, the decision was made to proceed with aspiration with absolute alcohol irrigation with the hope that it would yield a satisfactory combination of safety, efficacy and low recurrence risk.

After making a paracentesis, dispersive viscoelastic was injected into the anterior chamber to protect the corneal endothelium. A single 30-gauge needle was used to aspirate the cyst, whereas another 2 syringes were used to inject and aspirate absolute alcohol to and from the cyst cavity twice. After irrigation, the anterior chamber was washed with balanced salt solution, causing the cyst to visibly collapse.

Post-operatively, the patient had a collapsed cyst cavity and transient corneal edema, but did not develop severe intraocular inflammation, IOP elevation, hypotony or cataract formation. His postoperative regimen included the following drops: topical steroids (prednisolone acetate) 4-6x/day, hypertonic sodium chloride 5% 4x/day, topical antibiotic (moxifloxacin) 4x/day, and topical antibiotic ointment (erythromycin nightly plus as-needed for irritation). He ultimately required a subsequent repeat cyst aspiration (without absolute alcohol) for recurrence, and his visual acuity improved to 20/25.

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