Figure 1. Single, unilateral, translucent anterior vitreous cyst with smooth margins, spherical shape, and pigmented surface as seen in the left eye of a patient who reported a floater.
Figure 2. The patient's anterior vitreous cyst seen in the backdrop of the retina. It was safely observed for 1 year without any complications.
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Gupta SR, Gupta N, Anand R, Dhawan S. Idiopathic Pigmented Vitreous Cyst. Arch Ophthalmol. 2012;130(11):1494–1496. doi:10.1001/archophthalmol.2012.175
Idiopathic floating vitreous cysts are very rare. They often give rise to intermittent blurring of vision. Only a few clinical and histopathological reports document features of such cysts, but the origin of these cysts is still a matter of debate. We describe the ophthalmic assessment of a cyst suspended in the anterior vitreous cavity of a 48-year-old patient who visited the Vasan Eye Care Hospital, New Delhi, India.
A 48-year-old man had a mobile, insectlike floater in the central visual field of his left eye for 4 years. There was no history of trauma, inflammatory ocular disease, or infectious ocular disease. Visual acuity was 20/20 OU. There were no signs of inflammation in the anterior chamber, and the media were transparent. The iris was normal in both eyes; the pupils were normal in size and shape and were normally reacting. Intraocular pressure was 17 mm Hg OU. The crystalline lens was transparent and in normal position in each eye. Posterior segment examination findings were normal in each eye except for an anterior vitreous cyst in the left eye.
The cyst was spherical in shape, was translucent, had a smooth surface, and was covered with a brown pigment (Figure 1 and Figure 2). It was moving freely with the movements of the eyeball.
The patient was of moderate size and had no history of any illness. Results of all blood tests (complete blood cell count, erythrocyte sedimentation rate, and serology for cysticercoids, Echinococcus, Toxoplasma gondii, and Toxocara species) were negative. Findings on stool examination for detection of ova and cyst were also negative. Chest radiography, abdominal ultrasonography, and brain computed tomography revealed no pathological finding. The patient was given the options of laser photodisruption or vitrectomy to excise the cyst, but he declined any intervention. During the next year, the cyst was observed and there was no change.
Tansley1 was the first person to describe a free-floating vitreous cyst in 1899. They are either congenital or acquired. Congenital ones are often associated with remnants of the primary hyaloidal system and can be pigmented or nonpigmented.2 Acquired ones are secondary to intraocular pathological findings such as intraocular infection, uveitis, retinoschisis, and retinitis pigmentosa. They have also been found secondary to trauma and retinal reattachment surgical procedures.
Cruciani et al3 reviewed the literature on morphologic and clinical correlations. Most patients were aged 10 to 20 years (range, 5-68 years). Dimensions of the cyst ranged from 0.15 to 12 mm. The shapes were described as spherical, oval, or lobulated, while the surface could be smooth or crenated. The color was yellow-gray (nonpigmented) or brown (pigmented).
Orellana et al4 examined the vitreous cysts by electron microscopy and detected predominantly large mature melanosomes associated with scattered immature ones (premelanosomes); they hypothesized that the origin of the cysts was from pigment epithelium secondary to trauma. Later, on histopathological examination, Nork and Millecchia5 detected pigment epithelial–type tissue with immature melanosomes (not seen after birth in normal pigment epithelium), Mittendorf dot, and position at the Cloquet canal, all of which favored the hypothesis of a choristoma of the primary hyaloidal system. The therapeutic approach to a vitreous cyst depends on the severity of the symptoms, the cyst's characteristics and location, and the patient's desire for treatment. Most cysts in the vitreous cavity may be observed and followed up without any intervention. Treatment consists of either laser disruption of the cyst or pars plana vitrectomy with cyst excision.5,6 In our case, the cyst was followed up for 1 year without any increase in the size of the cyst or any other complications. It is therefore very important to differentiate these idiopathic vitreous cysts clinically from other infectious and malignant conditions to avoid unnecessary aggressive treatments. As described in our case and in the literature,2 they can be safely observed for long periods without any complications.
Correspondence: Dr S. R. Gupta, Vasan Eye Care Hospital, Parvetesh Towers, 36B Pusa Rd, Opposite Metro Pillar 125, New Delhi, 110060, India (firstname.lastname@example.org).
Conflict of Interest Disclosures: None reported.