Iridociliary cysts do not impact on posterior phakic intraocular lens implantation for high myopia correction: A prospective cohort study in 1569 eyes
Iridociliary cysts do not impact on posterior phakic intraocular lens implantation for high myopia correction: A prospective cohort study in 1569 eyes
Xi Zhang 0 1 2
Xun Chen 0 1 2
Xiaoying Wang 0 1 2
Xingtao Zhou 0 1 2
0 Department of Ophthalmology, Eye and ENT Hospital of Fudan University , Shanghai , PR China
1 Department of Ophthalmology, Myopia Key Laboratory of the Health Ministry , Shanghai , PR China
2 Editor: Andrew W Taylor, Boston University School of Medicine , UNITED STATES
A total 1569 eyes of 866 high myopia patients, who underwent phakic intraocular lens implantation from 1 September 2011 to 31 August 2016, was included in this prospective cohort study. These patients were followed up for more than 12 months postoperatively.
Data Availability Statement: All relevant data are
within the paper and its Supporting Information
Funding: This work was supported by the
Shanghai Shenkang Hospital Development Center
(Grant No. SHDC12016207) and the Health and
Family Planning Committee of Pudong New District
of Shanghai (Grant No. PW2014D-1) to Xiaoying
Wang. The funders had no role in study design,
data collection and analysis, decision to publish, or
preparation of the manuscript.
To investigate the clinical characters and effect of iridociliary cysts among patients who had
undergone posterior phakic intraocular lens implantation.
During the study period, 218 eyes (14%) of 154 patients were diagnosed with iridociliary
cysts by ultrasound biomicroscopy. There were 74.3% patients with unilateral cysts and the
cysts tended to have occurred in patients ages 20 to 30 years old (22%). The location of the
cysts varied with temporal position as the most (50%) and superior position as the least
(9.6%). After 1 week postoperative follow-up, there were no significant differences in clinical
outcomes between the cysts group and no cysts group, but the proportion of 20/20 or better
uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and the 2 types of
vector astigmatism. Intraocular pressure (IOP), refraction, and vault remained stable at
different time points of the follow-up period, while vault of cysts patients tend to be lower than
patients without cysts at more than 12 months.
Iridociliary cysts were more common than estimated and it had no impact on Phakic
Intraocular Lens implantation because there was no clue to show significantly difference on
postoperative clinical outcomes between the patients with and without iridociliary cysts in this
In December 2005, the Implantable Collamer Lens (Visian ICL; STAAR Surgical, Nidau,
Switzerland), a posterior phakic intraocular lens, was approved for commercial use in the
treatment of myopia -3.00D to -20.00D. Then, the Toric Implantable Collmer lens (TICL) was
developed to correct -3.00 to -6.00D astigmatism. Currently, the ICL/TICL is widely used for
high myopia on a global basis, because this new lens has a greater safety record and has proven
to be more effective than laser corneal surgery.[1?4]
Since ICL/TICL was introduced in our hospital, we have been made aware of an increase in
the number of iridociliary cysts cases. Iridociliary cysts, the majority of which were located at
the iris-ciliary body junction or the top of ciliary processes, were benign cyst lesions.[
are rarely found by slit-lamp examination, gonioscopy, or optical coherence tomography
] The large iridociliary cysts can cause anterior chamber angle closure and increase
the risk of secondary glaucoma.[8?10] For ICL/TICL implantation, many surgeons take more
concern into the cysts impacting on the ideal location and vault of implantable lens in a
postoperative short period. And in the long term, whether the ICL/TICL implantable stimulates
the iridociliary cysts growth or changes the aqueous humor generation is also noted by many
researchers. In traceable study results,[
7, 11, 12
] the incidence of iridociliary cysts ranged from
4.9% (1157 patients) to 54.3% (116 patients); there has been no consensus and the clinical
outcome of only one patient case, who had undergone treatment with the Toric Implantable
Collamer Lens, has been reported.
Thus, could Posterior Phakic Intraocular Lens Implantation be performed among patients
with iridociliary body cyst and how were the postoperative long-term safety and stability
compared with the patients without cysts? These were the primary questions investigated during
Materials and methods
866 patients (1569 eyes) who had undergone implantation with ICL / Toric ICL (STARR
Surgical) for the correction of myopia astigmatism between 2010 and 2016 were involved in this
study. Informed consent was provided by the participants and the principles outlined in the
Declaration of Helsinki were followed in this study. All patients included in this study had to
have met these criteria: spectacle and/or contact lens intolerance; stable refraction for at least 1
year before preoperative examination; an endothelial cell density (ECD) 2000 cell/mm2;
anterior chamber depth 2.8 mm; and no history of cataract, glaucoma, uveitis, uncontrolled
diabetes, collagen vascular disease, or previous intraocular surgery. This work is granted
permission by the Ethics Committee of Eye and ENT Hospital, Fudan University.
Main measurement parameters
In this study, the main measurement parameters were: uncorrected visual acuity (UCVA); best
corrected visual acuity (BCVA); manifest and cycloplegic refraction; corneal keratometry;
intraocular pressure (IOP); iridociliary cysts' number, size, location by ultrasound
biomicroscopy (UBM) preoperative and postoperative. Besides, postoperative vault and adverse events
were important parameters for evaluation. All examinations were taken in the operative eyes.
The following statistical analyses were used to compare visual outcomes of the 2 types of high
myopia patients after implantation. SPSS statistics software package version 18.0 for Windows
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(SPSS, Chicago, IL, USA) was used for statistical analysis. The Fisher exact test was performed
on dichotomous variables (BCVA or UCVA, 20/20, and 20/40 or better, predictability of ?0.50
or ?1.00D). Mann?Whitney U tests were performed to explore statistical differences for
refractive index, efficacy index, safety index, intraocular pressure, and vault among different
patient subgroups. p<0.05 was considered significant in all cases.
This study involved 866 patients (1569 eyes) who underwent ICL/TICL (version 4) and
prospected the short-term/long-term clinical outcomes. The mean age of the subjects was
29.30?7.74 years old (range: 18 to 55 years old) and the manifest refraction spherical
equivalent (MRSE) was -15.41 ?4.58 D. Among the 866 patients (1569 eyes), 154 patients (218 eyes)
had iridociliary cysts. Table 1 provides a comparison of demographics and preoperative sphere
and cylinder for the cysts group and no cysts group. We noticed that patients with iridociliary
cysts were significantly younger, with 2.2 years difference in average age and with less myopia
We evaluated 866 patients (1569 eyes) at the following time points: 1 day after surgery, 1 week
after surgery with a clinical analysis including UCVA, BCVA (only at 1 week), refraction (only
at 1 week), intraocular pressure (IOP), and vault (only at 1 week; the distance between the
front surface of crystalline lens and the back surface of Implantable Collamer Lens, Fig 1). We
followed up on174 patients (289 eyes) for more than 12 months among the 866 patients and
evaluated the clinical examination (UCVA, BCVA, refraction, IOP, vault measurement) at 1
month, 3 months, 6 months and 12 months (the last visit). The mean follow time of last visit
in two groups was 16.96 +/- 7.75 months and 19.18 +/- 9.04 months, respectively.
Clinical characters of iridociliary cysts
As mentioned above, 218 (14%) of 1569 eyes were diagnosed with iridociliary cysts. Patients
aged between 20 and 30 years old had the highest incidence rate (105/474; 22%) of iridociliary
cysts, compared with the incidence rate in patients under 20 years old (16%), in patients
ranging in age from 31 to 40 years old (15%), and in patients over 40 years old (5%).
The 218 eyes of 154 patients with iridociliary cysts had different characters of distribution
(unilateral or bilateral), numbers (single or multiple), location, and size. Among the 154
patients, 138 patients underwent binocular ICL/TICL implantation. There were 75 (54.3%) of
138 patients with unilateral cysts, compared with 63 (45.7%) of 138 patients (63/138) with
bilateral cysts. The proportion of eyes with a single cyst was 50% (109/218); this equaled the
Fig 1. Image of ultrasound biomicroscopy after phakic intraocular lens implantation. A: front surface of
Implantable Collamer Lens; B: back surface of Implantable Collamer Lens; C: front surface of crystalline lens; D: vault;
E: corneal; F: nasal and temporal iris; G: nasal and temporal ciliary sulcus.
number of eyes having multiple cysts. The iridociliary cysts had 8 locations in the eyes,
including nasal (14%), superior nasal (10%), inferior nasal (16.5%), temporal (50%), superior
temporal (36%), inferior temporal (41%), superior (9.6%) and inferior (29%). All cysts were less than
1 mm except in one eye of a female patient; this one cyst was quite large with a diameter >2
mm (Fig 2). In the 2 eyes (1.9%) of one patient, cysts were detected almost completely around
the 360? ciliary body.
Fig 2. Image of the patients who had a huge iridociliary body cysts at the ciliary sulcus. The arrow shows the
iridociliary body cysts.
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Fig 3. Iridociliary body cysts group versus patients without iridociliary body cysts uncorrected visual acuity
(UCVA) 20/20 or better and 20/40 or better at postoperative one day and one week. ( : P<0.05; : P<0.01; cysts
group: 1 day, n = 207; 1 week, n = 205; no cysts group: 1 day, n = 1216; 1 week, n = 1068).
Short-term clinical outcomes
All eyes had an uncorrected visual acuity (UCVA) of 20/200 or worse prior to surgery. After
the implantation of ICL/TICL, the UCVA of 2 groups improved dramatically. In both groups,
the proportions of cases achieving the 20/40 or better UCVA (Fig 3, p>0.05) and 20/40 or
better BCVA in both groups (Fig 4, p>0.05) had no significant statistical differences in each
Fig 4. Iridocilirary body cysts group versus patients without iridocilirary body cysts best corrected visual acuity
(BCVA) 20/20 or better and 20/40 or better at pre-operate and postoperative one week. ( : P<0.01; cysts group:
pre-op, n = 218; 1 week, n = 205; no cysts group: pre-op, n = 1351; 1 week, n = 1068).
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No cysts group
follow-up visit. However, the proportion of cases with 20/20 or better UCVA in group with
cysts was significantly higher than the other group at one day and 1 week postoperatively (Fig
3, p<0.01; p<0.001). Besides, at 1 week and preoperative, the proportions of cases achieving
the 20/20 or better BCVA (Fig 4, p<0.01; p<0.001) showed the same significantly difference
with 20/20 or better UCVA.
The efficacy index (mean postoperative UCVA/mean preoperative BCVA) and safety index
(mean postoperative BCVA/mean preoperative BCVA) in cysts group were 1.11+/-0.34 and
1.35+/-0.45, respectively, during the 1week follow-up visit period. The efficacy index and safety
index were 1.16+/-0.55 and 1.48+/-1.03, respectively in the second group. Both the safety
index and efficacy index showed no significant differences between the 2 groups (p>0.05).
The mean spherical equivalent, J45 astigmatism (axes at 45? and 135?) and J0 astigmatism
(axes at 180? and 90?) have no statistical difference at 1week after the implantation surgery
(Table 2). Compared to the proportion of predictability (attempted versus achieved correction)
for ?0.50 D and ?1.00 D between the 2 groups, there was no different at 1 week visit period.
(Fig 5; p>0.05).
Fig 5. Predictability for ?0.50 D and ?1.00D of iridocilirary body cysts group versus patients without iridociliary
body cysts during the 1week postoperative period.
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Short-term intraocular pressure and vault
Long?term clinical outcomes and changes of iridociliary cysts
Clinical outcomes. A total of 289 eyes (174 patients) were followed for more than 12
months. Among them, there were 108 eyes of 74 patients that had iridociliary cysts and 181
eyes having no cysts. During the last visit period, the efficacy index (1.09?0.36 vs 1.08?0.35;
P>0.05) and safety index (1.30?0.36 VS 1.23?0.39; p>0.05) of the 2 groups showed no
statistically significant differences. The mean spherical equivalent in the cysts group was statistically
lower than the no cysts group, only at the one month visit (Fig 6; -0.29?0.62D vs -0.48?0.74D,
Fig 6. Change of mean spherical equivalent in the 2 groups at pre-operate and different postoperative visit
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Fig 7. Change of J45 astigmatism of the 2 groups at pre-operation and at different postoperative visit periods.
p<0.05). With statistically different preoperative J45 astigmatism of the 2 groups (Fig 7; -0.19
?0.84D vs 0.05?0.64D, p<0.05), we found that J45astigmatism in the cysts group was lower
than the no cyst group at 1 month (-0.08?0.46D vs 0.12?0.49 D, p<0.05). Both the mean
spherical equivalent and the 2 types of victor astigmatism of 2 groups, remained stable at all
visits (Figs 7 and 8).
At the 3-month postoperative visit period, IOP in cysts groups was significantly higher
than the no cysts group (16.12?2.73mmHg vs14.43?3.02 mmHg, p<0.05), while the vault of
the cysts group was lower than the other group at the last visit period (398.52?170.36 ?m vs
502.73?254.94 ?m, p<0.05). Figs 9 and 10 show trends in IOP and vault at all follow-up
visits. We noticed that in both groups, intraocular pressure kept stability and had no
significant difference at every follow-up visit while the vault in cysts group showed more tended
to decrease than the no cysts group. However, the proportion of ideal vault (ranges from
250?750 ?m) in the 2groups was no significant difference at all visit time period (Fig 11;
Changes of iridociliary cysts. A total of 33eyes with iridociliary cysts, who had
undergone implanted ICL/TICL were examined by ultrasound biomicroscopy in October, 2017.
The mean follow time was 35.4 +/- 15.75 months (ranged from 7 to 72months). The mean
cyst diameter was 0.94+/- 0.41mm (ranged from 0.5 to 1.87mm). We mainly observed
whether the cysts changed in quantity and position between preoperative and the last visit
after surgery. Most eyes (16 eyes, 48.5%) had no changes, while the inferior iridociliary body
cyst diameter in only 1eye became larger than preoperative. Among 9 eyes with cysts, 8eyes
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Fig 8. Chang of J0 astigmatism in the 2 groups at pre-operation and different postoperative visit periods. :
showed the preoperative existed cysts disappeared completely and 1 eye exhibited that only
the inferior cysts had disappeared. There was no statistically significant difference in age
(P>0.05) in each group. Table 4 shows the changes in 33 eyes with iridociliary cysts at the
Adverse events. In the process of long-term follow-up, no eye in our study had any
intraoperative complications (Table 5). In the group without cysts, 5 (2.8%) of 181 eyes had
symptoms of glare after implantation surgery. Meanwhile, there were 3 eyes (2.1%) that had
the same symptoms in the other group. We noted the dark pupil diameters of all eyes were
larger than 7.0 mm, and 4 eyes dark had pupil diameters that were larger than 7.5mm.
Symptoms of glare persisted only for a short period.
For one patient, there were the need to adjust the ICL position due to the high vault
(>1100?m) at the one week follow-up visit, and in one patient the need to adjust the TICL
axial because of the increased astigmatism at the 12 months visit time period in the group
without cysts. After the adjustment, the vault decreased to less than 1000?m; the astigmatism
of the other patient was corrected.
Fundus disease was detected in both groups after surgery. At 20 months post initial surgery,
one eye in the no cysts group experienced macular hemorrhage; this did not cause the
significant decrease of BCVA, and one eye in cysts group occurred retinal detachment 25 months
after surgery, which lead to a loss of 7 lines in BCVA compared to preoperative.
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Fig 9. Change in intraocular pressure in the 2 groups at pre-operation and different postoperative visit periods. :
Since the advent of ultrasound microscopy in early 1990s, we started to become more familiar
with iridociliary cysts. These cysts were far more common than we had estimated. One case
having solitary temporal iris cysts had been reported to followed up 15 months after TICL
implantation and there was no impact on final visual outcome or TICL position.[
] In our
study, we identified the characters of iridociliary cysts and evaluated the cysts effects on clinical
outcomes of ICL/TICL implantation at different postoperative visit periods.
Among the 1569 eyes of 866 patients in present study, we found the prevalent of iridociliary
cysts was 14%, which was closer to previous 4.9% of 1157 patients. Similar to a previous study,
] these cysts were more commonly diagnosed in women (67%) and at approximately 20 to
30 years of age (22%). Most cysts located at the temporal, superior temporal, inferior temporal.
ICL/TICL was implanted to the posterior chamber and the implantable lens' haptics were
positioned into the sulcus. Since iridociliary cysts most commonly appear at the iridosciliary
body junction or the top of ciliary processes, the haptics may be affected by the ciliary cysts. If
the haptics are not placed into the appropriate position, the corrective effect and lens' stability
will be affected.[
] Meanwhile, at one day after ICL/TICL implantation, clinical outcomes
including UCVA, BCVA, IOP, and vault may not reflect the real outcomes because of the
small pupil and a greater tendency to be influence by various factors. While at postoperative
one week period, the visual outcomes, refractive outcomes, IOP and Vault could keep stable in
] Therefore in this study, we followed 1569 eyes of 866 patients at 1 day and 1
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Fig 10. Change in vault in the 2 groups at different postoperative visit periods. : p<0.05.
week and 289eyes of 176 patients, who were followed over 12months after phakic intraocular
lens implantation to evaluate the effect of iridociliary cysts at different visit periods.
After the one week follow-up period, the MSE, 2 types of vector astigmatism (J0, J45) of two
groups were corrected adequately in the 2 groups. Based on the analyses of the results, we
noticed that except for the proportion of UCVA 20/20 or better and the proportion of BCVA
20/20 or better in cysts group exhibiting higher than no cysts group which might due to the
statistical preoperative significant difference in BCVA 20/20 or better (p<0.05). Predictability
for ?0.50 D and ?1.00D and refractive outcomes showed no significant difference, which
indicated that this current study is a fairly representative of the outcomes reported with approved
implantable collamer lens clinical trials.
At the process of over 12 months follow-up, we noticed both groups' mean spherical
equivalent, J0 and J45 astigmatism remained stable at all postoperative visit periods. Furthermore,
we compared more than 1year postoperative iridociliary cysts changes in size, number, and
position, with preoperative, and we noticed that the cysts changed in half of the eyes. Among
the changing cysts, most eyes (27.3%) had cysts disappearing and we speculated that because
the haptics of ICL might break the cysts intraoperative. Thus far, we could not determine the
relationship between phakic IOL implantation and iridociliary cysts changes due to the small
sample. In the future, we could enlarge the sample size and further analyze in order to acquire
the more substantial evidence.
A posterior chamber phakic intraocular lens, with the haptics on the ciliary sulcus, is
designed to be implanted in the posterior chamber behind the iris and in front of the anterior
capsule of the crystalline lens.[
] The haptics and anterior vault are to minimize contact
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Fig 11. The ideal vault (250?750 ?m) proportion of the 2 groups at different postoperative visit periods.
with the crystalline lens. Achieving an ideal vault is one of the factors to as a certain
postoperative safety. Gonvers at al [
] reported that poorly-sized vault will lead to some
complications such as to cataracts, angle-closure glaucoma, and pigment dispersion syndrome. The
vault could be affected by various factors such as ICL/TICL sizes, age, ACD, and haptic
] In our study, The vault in the cysts group decreased more significantly than in the
no cysts group which we supposed to be due to the difference in sample size. However, the
proportion of patients having an ideal vault show no statistical difference at all postoperative
Some study reported that the large iridociliary cysts would cause anterior chamber angle
closure and increase the risk of secondary glaucoma. We followed the only one eye of a patient
in our study who has a ciliary body cyst diameter >2mm and found that the spherical
equivalent ranged from 0 D to +0.50 D, the IOP and vault were 17.4mmHg and 460?m at 12 months
follow up visit. More cases with huge iridociliary cysts could be evaluated in the future to
summarize the character of the >2mm diameter iridociliary cysts. Mc Whae et al [
] described 73
patients with multiple bilateral iridociliary cysts using ultrasound microscopy and found that
9.1% cases occurred glaucoma requiring treatment and 9.1% cases had a narrow angle. In
addition, the cyst-related glaucoma occurred in patients that had multiple areas of angle
compromise due to large cysts. This study did not investigate the safety and effectiveness between
multiple and single iridociliary cysts patients after ICL/TICL implantation. In future, we could
perform a prospective study to further explore this area.
In conclusion, iridociliary cysts are mostly located on the temporal (including temporal,
superior temporal, inferior temporal) of the eyes and the diameters of cysts usually less than
1mm. There was no impact on the postoperative 1 week and over 12 months clinical outcomes
in cysts group and they did not increase the intra-operative and postoperative risk.
Furthermore, most iridociliary cysts have no changes in size, number after long term postoperative
follow-up visit. The results in our study indicate that ICL/TICL implantation could performed
in patients with iridociliary cysts.
S1 File. Minimal data. Partial data of some parameters examined before the operation. IOP:
intraocular pressure; WTW: distance of white to white; K: keratometry; ACD: anterior
We thank Qian Chen of the Eye Department of Eye and ENT Hospital of Fudan University for
her helpful advice.
Data curation: Xi Zhang.
Formal analysis: Xi Zhang.
Funding acquisition: Xiaoying Wang.
Investigation: Xi Zhang, Xun Chen.
Supervision: Xiaoying Wang, Xingtao Zhou.
Validation: Xiaoying Wang, Xingtao Zhou.
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Visualization: Xi Zhang, Xun Chen.
Writing ? original draft: Xi Zhang.
Writing ? review & editing: Xiaoying Wang.
1. Sanders DR , Doney K , Poco M , I. C. L in Treatment of Myopia Study Group. United States Food and Drug Administration clinical trial of the Implantable Collamer Lens (ICL) for moderate to high myopia: three-year follow-up . Ophthalmology 2004 ; 111 ( 9 ): 1683 ? 1692 . https://doi.org/10.1016/j.ophtha. 2004 . 03 .026 PMID: 15350323
2. Sanders DR , Schneider D , Martin R , Brown D , Dulaney D , Vukich J , et al. Toric Implantable Collamer Lens for moderate to high myopic astigmatism . Ophthalmology 2007 ; 114 ( 1 ): 54 ? 61 . https://doi.org/10. 1016/j.ophtha. 2006 . 08 .049 PMID: 17198849
3 . Chang JS , Meau AY . Visian Collamer phakic intraocular lens in high myopic Asian eyes . J Refract Surg 2007 ; 23 ( 1 ): 17 ? 25 . PMID: 17269240
4. Sanders DR , Sanders ML . Comparison of the toric implantable collamer lens and custom ablation LASIK for myopic astigmatism . J Refract Surg 2008 ; 24 ( 8 ): 773 ? 778 . PMID: 18856230
5. Marigo FA , Esaki K , Finger PT , Ishikawa H , Greenfield D S , Liebmann J M , et al. Differential diagnosis of anterior segment cysts by ultrasound biomicroscopy . Ophthalmology 1999 ; 106 ( 11 ): 2131 ? 2135 . https://doi.org/10.1016/S0161- 6420 ( 99 ) 90495 - 5 PMID: 10571349
6. Cornut PL , Guillet C , Burillon C , Denis P. Ciliary body cyst: comparison of the biomicroscopy, UBM and OCT data . J Fr Ophtalmol 2010 ; 33 ( 9 ): 680 ? 681 . https://doi.org/10.1016/j.jfo. 2010 . 06 .017 PMID: 20728243
7. Kunimatsu S , Araie M , Ohara K , Hamada C . Ultrasound biomicroscopy of ciliary body cysts . Am J Ophthalmol 1999 ; 127 ( 1 ): 48 ? 55 . PMID: 9932998
8. Thomas R , Mulligan N , Aylward GW , Billson FA . Angle closure glaucoma due to iris and ciliary body cysts . Aust N Z J Ophthalmol 1989 ; 17 ( 3 ): 317 ? 319 . PMID: 2803778
9. Ritch R , Chang BM , Liebmann JM . Angle closure in younger patients . Ophthalmology 2003 ; 110 ( 10 ): 1880 ? 1889 . PMID: 14522758
10. Seki M , Fukuchi T , Yoshino T , Ueda J , Hasebe H , Ueki S , et al. Secondary glaucoma associated with bilateral complete ring cysts of the ciliary body . J Glaucoma 2014 ; 23 ( 7 ): 477 ? 481 . https://doi.org/10. 1097/IJG.0b013e31827a088c PMID: 25170979
11. Aman-Ullah M , Gimbel HV , Camoriano GD . Toric implantable collamer lens implantation in a case with bilateral primary peripheral iris cysts . Ophthalmic Surg Lasers Imaging 2012 ; 43 Online: e18 - 21 .
12. Cronemberger S , Ferreira DM , Diniz Filho A , Merula RV , Calixto N. Iridociliary cysts on ultrasound biomicroscopic examinations . Arq Bras Oftalmol 2006 ; 69 ( 4 ): 471 ? 475 . PMID: 17119715
13. Shields JA , Kline MW , Augsburger JJ . Primary iris cysts: a review of the literature and report of 62 cases . Br J Ophthalmol 1984 ; 68 ( 3 ): 152 ? 166 . PMID: 6696869
14. Shi M , Kong J , Li X , Yan Q , Zhang J . Observing implantable collamer lens dislocation by panoramic ultrasound biomicroscopy . Eye (Lond) 2015 ; 29 ( 4 ): 499 ? 504 .
15. Sanders DR , Vukich JA , Doney K , Gaston M. Implantable Contact Lens in Treatment of Myopia Study Group. U.S. Food and Drug Administration clinical trial of the Implantable Contact Lens for moderate to high myopia . Ophthalmology 2003 ; 110 ( 2 ): 255 ? 266 . PMID: 12578765
16. Sari ES , Pinero DP , Kubaloglu A , Evcili P S , Koytak A , Kutluturk I , et al. Toric implantable collamer lens for moderate to high myopic astigmatism: 3-year follow-up . Graefes Arch Clin Exp Ophthalmol 2013 ; 251 ( 5 ): 1413 ? 1422 . https://doi.org/10.1007/s00417-012 -2172-8 PMID: 23052720
17. Gao J , Liao RF , Li N. Ciliary sulcus diameters at different anterior chamber depths in highly myopic eyes . J Cataract Refract Surg 2013 ; 39 ( 7 ): 1011 ? 1016 . https://doi.org/10.1016/j.jcrs. 2013 . 01 .040 PMID: 23582363
18. Gonvers M , Bornet C , Othenin-Girard P . Implantable contact lens for moderate to high myopia: relationship of vaulting to cataract formation . J Cataract Refract Surg 2003 ; 29 ( 5 ): 918 ? 924 . PMID: 12781276
19. Kamiya K , Shimizu K , Komatsu M. Factors affecting vaulting after implantable collamer lens implantation . J Refract Surg 2009 ; 25 ( 3 ): 259 ? 264 . PMID: 19370820
20. McWhae JA , Rinke M , Crichton AC , Van Wyngaarden C. Multiple bilateral iridociliary cysts: ultrasound biomicroscopy and clinical characteristics . Can J Ophthalmol 2007 ; 42 ( 2 ): 268 ? 271 . PMID: 17392851