A 37-year-old hyperopic male who, on routine examination, discovered an intraocular pressure (IOP) of 34 mmHg in the right eye (OD) and 32 mmHg in the left eye (LE).
Gonioscopy showed angular closing signs in both eyes that led to bilateral iridotomies with Nd:YAG laser.
At two weeks there were still signs of angular closure despite being permeable iridotomies and IOP was 33 mmHg (OD) and 36 mmHg (OI).
An ultrasonic biomycosis (UBM) was performed to detect an iris-plateau configuration with angular closure secondary to multiple irido cysts.
The cysts presented hyperpigmented walls with hypopigmented liquid content, suggesting the diagnosis of primary neuroepithelial cysts.
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It was decided to treat OI by argon laser iridoplasty (impact size 500 μm, 0.5 seconds of exposure and 500 mW of power).
The same attitude was offered for the RE, but the patient preferred conservative treatment with hypotensive medication (thymolol 0.5% every 12 hours) to see the response to laser treatment.
After iridoplasty the BMU was repeated showing the change of configuration of the convex to concave iris root, as well as the disappearance of the cysts.
IOP decreased to 17 mmHg without treatment.
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One month later, an IOP of 18 mmHg was maintained in OI without medication and 14 mmHg in OD with Timolol.
In the BMU, it was possible to observe the reappearance of cysts in the eye treated with laser, without producing a secondary angular block.
This situation was maintained for 6 months, then reappearing in plateau iris configuration of the IO and increasing IOP to 28 mmHg.
At this time, it was decided to treat this eye with hypotensive medication such as the right one, since it maintained adequate intraocular pressure (14 mmHg).
The patient declined any other treatment other than medical, as he tolerated the medication very well and achieved adequate blood pressure control.
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Currently, after 12 months of follow-up, the patient shows an IOP of 14 mmHg in both eyes with Timolol 0.5% every 12 hours.
In the BMU multiple neuroepithelial cysts are still observed in both eyes, without showing increase in size or number or presenting the clinical patient with angular closure.
