Sir,

Vitreous cysts are rare structural entities that have been reported sporadically in the literature. Several associations have been described, including retinitis pigmentosa, Toxoplasmosis, trauma, chorioretinal atrophy, and Wagner disease.1 We present the first report of a vitreous cyst attached to the peripheral retina in a patient with intermediate uveitis.

Case report

A 31-year-old woman presented with a 3-day history of floaters in her left eye. There was no past medical or ophthalmic history of note. On examination, her visual acuity was 6/5 bilaterally. Her anterior segments were unremarkable and fundoscopy revealed mild vitritis and vitreous snowballs along with peripheral vascular sheathing on the right. In addition, a 4 mm vitreous cyst attached to the superior equatorial retina was observed (Figure 1). The cyst was adjacent to an area of vascular sheathing and there was evidence of white snowballs on its wall (Figure 2). Vitreous and retina in the fellow eye were unremarkable.

Figure 1
figure 1

B-scan ultrasound of the vitreous cyst attached to the retina.

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Figure 2
figure 2

Colour photograph showing a vitreous cyst adjacent to an area of vascular sheathing (large arrow). Note the snowballs attached to the cyst's walls (small arrow).

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The patient was managed by observation, and 3 months later her symptoms had significantly improved with reduction of the vitreous activity. The vitreous cyst remained unchanged regarding its size, location, and clinical characteristics.

Comment

Although vitreous cysts have been reported more than a century ago, their pathogenesis remains unclear. They can be congenital or acquired, pigmented or not pigmented, and are usually free floating.1

Vitreous cysts in association with uveitis are extremely rare. Brewerton reported the presence of two vitreous cysts in a patient with irido-cyclitis.2 More recently, vitreous cysts have been observed in association with Toxoplasmosis and Nematode endophthalmitis.3, 4

This is the first report of a posterior vitreous cyst attached to the retina in a patient with intermediate uveitis. Vitreous manifestations in intermediate uveitis include vitreitis, aggregates of white exudates analogous to snowballs, and snowbank.5 The vitreous cyst in our case may be a coincidental finding or may represent the result of vitreous degenerative changes following chronic irritation from the adjacent inflamed retina. We could also speculate that the vitreous cyst may constitute a rare transformation of previous large or coalesced snowballs.

Clinicians should be aware of the possibility of vitreous cysts developing in patients with intermediate uveitis.