Muhammad Aman-Ullah MD Howard V. Gimbel MD Gimbel Eye Centre Calgary AB Canada

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. UBM of Iris Cysts in ICL Surgery 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

4. OD/OS -11.25 –1.00 X 015 20/15-2-11.25 –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 UBM of Iris Cysts in ICL Surgery • Results • 32 year-old male • Presented for TICL Implantation OU Nov 2009

5. UBM of Iris Cysts in ICL Surgery Results • 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

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

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

8. Open angle TICL temporal haptic in sulcus OD TICL temporal haptic pressing into the cyst OS UBM of Iris Cysts in ICL Surgery Results • 7 wks post-op • UCVA 20/20 OU • IOP 12 OU 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 UBM of Iris Cysts in ICL Surgery Results • 7 mos post-op • UCVA 20/15; 20/20 • IOP 15/18

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

11. UBM of Iris Cysts in ICL Surgery 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.

12. UBM of Iris Cysts in ICL Surgery 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.