|Year : 1959 | Volume
| Issue : 4 | Page : 96-98
Multiple bilateral cysts of the retina
Satya Dev Paul
The Muslim University Institute of Ophthalmology and The Gandhi Eye Hospital, Aligarh, India
|Date of Web Publication||7-May-2008|
Satya Dev Paul
The Muslim University Institute of Ophthalmology and The Gandhi Eye Hospital, Aligarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Paul SD. Multiple bilateral cysts of the retina. Indian J Ophthalmol 1959;7:96-8
A review of the literature indicates that this is a disease of infrequent occurrence. eye (1936) reported a case of a man aged 64 years who complained of diminution of vision of both the eyes. A retinal cyst was seen in each fundus in the lower temporal region, but there was no detachment of the retina and there was no tear.
A similar case of bilateral symmetrical cysts of the retina was reported by Kornzweig (1940). This was the case of a man aged 33 years who complained of poor vision. In each fundus at the extreme periphery of the lower field at 6 O'clock, a spherical sharply defined elevation of the retina was seen. The colour of the elevation was greyish pink and the surface was slightly irregular and pitted.
Another case of bilateral symmetrical retinal cysts was reported by Paine (1955) in a man of 48 years.
| Case Report|| |
Mrs. K. B. aged 23 years, married, complained of sudden diminution of vision accompanied with headache, pain and redness of both the eyes of fifteen days duration.
On examination both the eyes were congested. The pupil reacted sluggishly to light and accommodation. Ocular tension on the day of examination was within normal limits.
Ophthalmoscopically in the right eye the media were clear and five cystic elevations of the retina of greyish pink colour with the vessels coursing over them were seen. The cysts were located at 12, 4, 7, 9, and 11 O'clock positions. The macula could not be seen. The arteries were slightly attenuated. The disc was pinkish in colour. The fundus was studded with flame-shaped haemorrhages and soft white exudates [Figure - 1] .
Left Eye media were clear and three cystic elevations of the retina were seen. The cysts were of greyish pink colour and the vessels were coursing on their surface. The anterior limit of the cysts could not be seen, as they were very far forwards. The cysts were located at 4, 7 and 9 O'clock positions. The fundus revealed a pinkish disc, flame-shaped haemorrhages and soft white exudates [Figure - 2].
No retinal tears could be made out in either eye.
General examination revealed an anaemic patient with a blood pressure of 162/120 mm. of Hg. The patient gave a history of having suffered from pulmonary tuberculosis in 1948 and 1950. She was treated along antitubercular lines. The lungs were clear when examined here.
| Laboratory Investigations|| |
Urine was loaded with Albumin ( + + +) , but there were no casts of renal epithelium.
X-ray chest showed a healed lesion in the right lung.
Sputum was negative for any acid fast bacilli.
Haemoglobin : 6o to 75%.
Total R.B.C.: 3.15 mill/cmm
Total W.B.C.: 13120/Cmm. with a relative leucocytosis of 72%.
E.S.R. (Westergren) : 75 mm. first hour.
The patient was put on complete bed rest and streptomycin injections and Isoniazid with Vitamin B Complex by mouth.
A tentative diagnosis of bilateral retinal cysts with albuminuric retinopathy was made.
After a few days it was decided to aspirate the cysts in one eye. The left eye cysts were aspirated. The aspirated fluid was straw coloured and chemical analysis indicated sugar 50 mgm. /l00cmm., proteins less than 3%. Cytology of the fluid did not indicate the presence of cells. The culture of the fluid was sterile. Intradermal Casoni's test was negative.
| Discussion|| |
Cyst formations along with detachment have frequently been reported in literature. Some of these cases have been found to occur in one eye by Ridley(1936) , (Weve (1936), Kurz (1938), and Jancke (1935). Weve (1936) reported 5 such cases where cystic formations were noticed in the far temporal periphery accompanied with retinal tears. Reports of infrequent occurrence of bilateral symmetrical cysts of the retina have appeared less frequently in literature by Kornzweig (1940), and Paine (1955).
Pathogenesis of bilateral retinal cysts has been rather obscure. Kornzweig (1940), Roveda and Riva (1951) regarded them as physiological as long as they stayed as small spaces. Histologically these spaces commence in the inner nuclear layer. They enlarge gradually till they occupy the whole space between the inner and outer limiting membrane. It was also remarked by Wolff (195i) that these cystic spaces were more common on the temporal side where the teeth of the ora serrata were small. Their origin is attributed to lack of blood supply at that region. Teng and Katzin (1953), who studied a large number of normal eyes removed postmortem for the purpose of corneal grafting, showed that cystoid changes at the ora serrata are part of the ageing process and that confluence and/or dilation of the microcysts is of frequent occurrence.
Teng and Katzin strongly support the theory, introduced by Ochi (1927) that accommodation is responsible, by reason of the motility which it causes in the neighbourhood of the ora for the development of peripheral cystoid degeneration.
Cyst formation in the retina has also been attributed to retinal oedema, to a break down of new formed glia, after a difficult labour, iridocyclitis, perforating injuries - Fuchs (1905), degene- rative conditions - Nuel, in syphilitic retinochoroiditis - Murakami (1901) and glaucoma - Holmes, Spicer and Parsons quoted by Wolff (1951).
Retinal folds occasionally occur in the early life of the embryo, specially near the ora serrata. It is possible that in rare cases such a told persists in adult life and at some period the space between the two layers of the folds enlarges to become a cyst (Elwyn 1947) A bilateral symmetrical situation of such embryonic folds which later develop into cysts is possible.
In the case described I am of the opinion that the patient did have retinal cysts of a small size to start with. The size being small, the patient never noticed any change in vision. As to the etiology of the cysts, it is conjectured that most likely it was a developmental anomaly to start with. Superimposed inflammation (albuminuric retinopathy) and anaemia caused a degenerative enlargement of the cyst, so much so as to interfere with vision. This sudden enlargement is however, unexplainable. It is quite possible though that the cysts may have been enlarging gradually, and, it was after the onset of retinopathy with papilitis that the patient became conscious of the diminution of vision. Francois and Rabaey (1953) regard such cases as exaggerations of peripheral cystoid degenerations.
Another interesting feature is the simultaneous onset in both the eyes. It may be pointed out that even in the retinal detachments affecting both eyes, usually there is an interval between the occurrence of the detachment in the first and the second eye, - Elwyn (1947). It is interesting to note that in such cases the tears and holes in the retina are frequently of the same kind in both the eyes and are often situated in symmetrical areas. These interesting points have been pointed out by Elwyn (1947), Bartel (1936), Gonin (1934) Arruga (1949), De Roth (1939), Gifford (1936), and Dunnington and Macnic (1935).
| Summary|| |
1. A case of bilateral retinal cysts is described and illustrated.
2. The age and sex of the patient indicates that the occurrence of bilateral cysts as reported in literature has no bearing on the disease.
3. The probable etiology in the face of lack of pathological evidence seems to be a developmental anomaly with a superimposed inflammation.
4. A brief review of the literature is given. It is pointed out that very few cases in literature have been recorded of bilateral retinal cysts.
The author gratefully acknowledges the helpful guidance of Prof. Tulsi Das, visiting Professor, M. U. Institute of Ophthalmology, Aligarh and his permission to publish this case
| References|| |
Arruga, H. (1949), Ophthalmologica, 118, 655
Bartel (1936), Klin Monatsbl f. Augenh, 96, 687.
De Roth, A. (1939), A. M. A. Arch. of Ophth., 22, 809.
Dunnington, J. H. and Macnic, J. D., (1935), A. M. A. Arch. of Ophth., 13, 191.
Elwyn, H. (1947), Diseases of the Retina, p. 469, Blakiston & Co., Philadelphia.
Francois, J. and Rabacy, M. (1953). Brit. J. Ophth., 33, 388.
Gifford, S. R. (1930,) A. M. A. Arch. of Ophthal. 16, 405.]
Gonin, J. (1934), le Decollement de la Refine Pathogenie-Traitment, Lausanne, librairie Payot et Co.
Jancke, G. (1y35), Klin Monatsbl. f. Augenh., 95, 145.
Kornzweig, A. L. (19.10), A. M. A. Arch_ of Ophth., 23, 491.
Kurz, O., (1938), Arch. f. Ophth., 139, 326.
Ochi, S. (1927), Amer. J. Ophthal., 10, 161.
Paine, D. L. E. (1955), Brit. J. Ophthal., 39, 122.
Ridley, H. (1936), Brit. J. Ophthal., 20, 65.
Roveda, J. M. and Riva, A. (1951), Arch. offal. (B. Aires), 26, 256.
Teng, C. C. and Katzin, H. M. (1953) Amer. J. Ophth., 36, 29.
Weve, H. (1936), Arch. f. Augenh., 109, 49.
Wolff, E.(1951) ,
Pathology of the Eye, p. 172, H. K. Lewis & Co., London.
[Figure - 1], [Figure - 2]