Coexistence of a free-floating pigmented vitreous cyst and ciliary body cysts

Abstract

Abstract Background Pigmented vitreous cysts are rare and generally benign intraocular lesions, but their origin remains uncertain. This case is noteworthy because multimodal imaging documented a free-floating pigmented vitreous cyst together with small bilateral temporal ciliary body cysts. Case presentation A 32-year-old woman was referred after an incidental fundus finding in the left eye. She reported no visual symptoms, had a best-corrected visual acuity of 20/20 in both eyes, and had no relevant ocular history. Slit-lamp biomicroscopy revealed a free-floating, spherical, pigmented cyst in the left vitreous cavity that was markedly mobile with eye movements. B-scan ultrasonography demonstrated a 2.27 × 2.14 mm cystic lesion in the mid-to-posterior vitreous without retinal or choroidal attachment. Multimodal imaging, including ultra-widefield photography, fundus autofluorescence, swept-source optical coherence tomography, and ultrasound biomicroscopy, showed absent intrinsic autofluorescence of the cyst with blockage of background retinal autofluorescence and small bilateral temporal ciliary body cysts. Conservative observation was undertaken. At 2- and 7-month follow-up, the patient remained asymptomatic, with no apparent change in the clinical appearance of the cyst. Conclusions Multimodal imaging can aid in the characterization of free-floating pigmented vitreous cysts and in the identification of associated anterior segment abnormalities. In this case, the coexistence of a vitreous cyst and bilateral temporal ciliary body cysts provides anatomic context for considering a possible displaced uveal pigment epithelial origin, although direct evidence of cyst detachment or migration was unavailable.