Iris implantation cysts growth five decades after trauma

Purpose: Implantation cysts of the iris are rare benign lesions resulting from epithelial downgrowth after trauma or surgery. This report highlights the management of an exceptional case of implantation cysts manifestation five decades after penetrating childhood trauma. Observation: A 59-year-old male patient with a history of penetrating trauma of the cornea at the age of 4 years presented with cystic anterior chamber lesions exhibiting pigment deposition. The pupil was distorted and almost entirely covered. 50 MHz ultrasound biomicroscopy and anterior segment optical coherence tomography displayed no evidence of malignancy. The cystic lesions were excised in an endothelium-protective manner and histopathological analysis revealed dysplasia-free corneal squamous epithelium compatible with implantation cysts of the iris. Conclusion and importance: Implantation cysts of the iris are benign and rare. Anterior segment imaging is required to exclude malignancies. Most cases emerge after surgery or trauma within months to a few years after injury. However, occurrence can also be delayed by several decades. It is thus mandatory to demand a full and long–lasting ophthalmological anamnesis, to accurately distinguish, diagnose, and treat cystic lesions of the iris.