OSLI Retina

October 2016

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■ I M A G E S I N O P H T H A L M O L O G Y ■ Dynamic Imaging of a Pigmented Free-Floating Vitreous Cyst Dilraj S. Grewal, MD; Sharon Fekrat, MD ABSTRACT: The authors present an incidental- ly noted pigmented anterior vitreous cyst in an asymptomatic male adult. Observation was elected. Stability during the course of 2 years and mobil- ity of the vitreous cyst using dynamic imaging are demonstrated. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:975-977.] A 55-year-old white male patient was referred for evaluation of a branch retinal vein occlusion (BRVO) in his left eye. Corrected vision was 20/32, limited by cystoid macular edema in his left eye. Dilated fundus examination of the right eye incidentally revealed an anteriorly located, translucent, and oval-shaped pig- mented vitreous cyst (Figure 1A). Fluorescein angiog- raphy performed to evaluate the BRVO in the left eye showed shadowing from the vitreous cyst in the right eye and absence of intra- or extra-cystic vasculariza- tion (Figure 1B). He denied visual blurring, floaters, or other visual disturbances in the right eye, and best- corrected visual acuity was 20/20. Medical history was relevant for metastatic renal cancer and hyper- tension. Cardiovascular workup and vascular imag- ing were negative. He denied any previous trauma or ocular surgery. The cyst was freely mobile in the anterior vitre- ous cavity with a brown-specked pigmentary pattern (Figure 2A to 2D). Autofluorescence was unremark- able. Given the visually asymptomatic nature of the cyst, it was observed. Repeat imaging of the right eye 2 years later confirmed stability of the cyst size, and the patient remained asymptomatic. Mobility of the cyst in the anterior vitreous was demonstrated on dynamic B-scan ultrasonography (video available at www.Healio.com/osliretina) and sequential widefield color photographs (Optos, Marlborough, MA) with eye movement (Figures 3A to 3D). We were unable to obtain optical coherence tomography images of the cyst due to its anterior location. Pigmented vitreous cysts can either be asymptom- atic or cause blurring or a floater-like condition. 1,2 From the Department of Ophthalmology, Duke University Medical Center, Durham, NC. Originally submitted April 30, 2016. Revision received April 30, 2016. Accepted for publication August 17, 2016. Supported by Heed Ophthalmic Foundation (San Francisco, CA) and the Ronald G. Michels Fellowship Foundation (Riderwood, MD) (DSG). The authors report no relevant financial disclosures. Address correspondence to Sharon Fekrat, MD, Department of Ophthalmology, Duke Eye Center, Duke University Medical Center, Durham, NC 27710; email: sharon.fekrat@duke.edu. doi: 10.3928/23258160-20161004-15 May 2016 · Vol. 47, No. 5 975

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