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Successful Long-term Management of Iris Flocculi and Miosis in a Patient With a Strong Family History of Thoracic Aortic Aneurysms and Dissections Associated With an MYH11 Mutation

Tyler B. Risma, BS1; Wallace L. M. Alward, MD1
[+] Author Affiliations
1Department of Ophthalmology and Visual Sciences, University of Iowa Carver College of Medicine, Iowa City
JAMA Ophthalmol. 2014;132(6):778-780. doi:10.1001/jamaophthalmol.2014.294.
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Primary pigmented epithelial iris cysts of the pupillary margin, or iris flocculi, are usually asymptomatic but can obstruct the pupil and decrease vision.1 We report successful long-term surgical management of a patient with visually significant iris flocculi and miosis. These were related to a strong family history of thoracic aortic aneurysms and aortic dissections (TAAD) associated with a mutation in the myosin, heavy chain 11, smooth muscle gene (MYH11).

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Figure 1.
Preoperative Slitlamp Photograph and Anterior Segment Optical Coherence Tomographic Image

Preoperative slitlamp photograph (A) and anterior segment optical coherence tomographic image (B) of the left eye, demonstrating numerous flocculi obscuring the pupil and restricting pupillary dilation to less than 1 mm.

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Figure 2.
Postoperative Slitlamp Photograph

Slitlamp photograph of the left eye after flocculi excision and radial sphincterotomies, increasing the pupil diameter to 5 mm. The patient had drastically improved vision in low light and complete resolution of photophobia.

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