{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:02:06Z","timestamp":1760058126401,"version":"build-2065373602"},"reference-count":11,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T00:00:00Z","timestamp":1742256000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>The aim of this study is to present interesting images of a clinical case of asymmetrical bilateral ciliary body cysts associated with pseudoexfoliative syndrome (PEX), leading to unilateral reverse pupillary block and subsequent secondary angle-closure glaucoma in a 64-year-old patient who presented with vision loss and redness, revealing angle-closure glaucoma in the left eye. Slit lamp examination showed an asymmetrical iris configuration between the eyes, with a normal appearance in the right eye and an inverted \u201cvolcano-shape\u201d iris appearance, corresponding to reverse pupillary block, with pseudoexfoliation in the left eye. Multimodal imaging confirmed the presence of bilateral ciliary body cysts, which were unexpectedly identified in the right eye. The patient\u2019s secondary angle-closure glaucoma in the left eye was likely due to anterior displacement of the iris from these cysts. Following an inadequate response to topical and systemic treatments, the patient underwent trabeculectomy in the left eye, successfully stabilizing the intraocular pressure (IOP) and leading to the resolution of the reverse pupillary block. This case underscores the importance of thorough ocular examination and multimodal imaging in diagnosing complex clinical presentations like secondary angle-closure glaucoma stemming from the combination of ciliary body cysts\u2019 pressure towards the angle, the pseudoexfoliative material component, and the reverse pupillary block configuration. All of the findings provided critical diagnostic clues leading to the identification of the underlying pathology.<\/jats:p>","DOI":"10.3390\/diagnostics15060758","type":"journal-article","created":{"date-parts":[[2025,3,18]],"date-time":"2025-03-18T06:02:40Z","timestamp":1742277760000},"page":"758","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Unilateral Reverse Pupillary Block Associated with Multiple Ciliary Body Cysts and Pseudoexfoliative Syndrome"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1912-3428","authenticated-orcid":false,"given":"Idoia","family":"Go\u00f1i Guarro","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia"},{"name":"Oftalmolog\u00eda M\u00e9dica y Quir\u00fargica (OMIQ) Research, 08036 Barcelona, Spain"},{"name":"Department of Medicine and Pharmacology, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mia","family":"Zori\u0107 Geber","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia"},{"name":"School of Medicine (UZSM), University of Zagreb, 10000 Zagreb, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ra\u0161eljka","family":"Tadi\u0107","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia"},{"name":"School of Medicine (UZSM), University of Zagreb, 10000 Zagreb, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renata","family":"Ivekovi\u0107","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zoran","family":"Vatavuk","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Hospital Centre Sestre Milosrdnice, 10000 Zagreb, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"269","DOI":"10.3928\/1542-8877-19920401-11","article-title":"Pigmentary dispersion syndrome and pigmentary Glaucoma: A New Mechanism Concept, a New Treatment, and a New Technique","volume":"23","author":"Karickhoff","year":"1992","journal-title":"Ophthalmic Surg. Lasers Imaging Retin."},{"key":"ref_2","first-page":"653","article-title":"Angle-closure glaucoma secondary to ciliary body cysts treated with subliminal transscleral cyclophotocoagulation. Report of a case","volume":"96","year":"2021","journal-title":"Arch. Soc. Espa\u00f1ola Oftalmol. Engl. Ed."},{"key":"ref_3","unstructured":"Garg BY, A., Murphy, J., and Al-Aswad, L.A. (2024, October 01). A Case of Ciliary Body Cysts. Available online: https:\/\/assets.bmctoday.net\/glaucomatoday\/pdfs\/gt1116_chall_Alaswad.pdf."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"254","DOI":"10.5935\/0004-2749.20180051","article-title":"Glaucoma Due to Ciliary Body Cysts and Pseudoplateau Iris: A Systematic Review of the Literature","volume":"81","author":"Schmalfuss","year":"2018","journal-title":"Arq. Bras. Oftalmol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e13","DOI":"10.1097\/IJG.0000000000001693","article-title":"Long-Term Follow-up of 14 Eyes with Bilateral and Multiple Ciliary Body Cysts: Prognosis of This Rare Entity","volume":"30","author":"Hugo","year":"2021","journal-title":"J. Glaucoma"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"100","DOI":"10.4103\/meajo.meajo_185_22","article-title":"Bilateral Multiple Ciliary Body Cysts with Angle-Closure Glaucoma in an 18-Year-Old Patient","volume":"29","author":"Almulhim","year":"2022","journal-title":"Middle East Afr. J. Ophthalmol."},{"key":"ref_7","first-page":"304","article-title":"Reversed Pupillary Block","volume":"22","author":"Blumenthal","year":"1991","journal-title":"Ophthalmic Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"103334","DOI":"10.1016\/j.pdpdt.2023.103334","article-title":"Clinical Applications of Anterior Segment Swept-Source Optical Coherence Tomography: A Systematic Review","volume":"42","author":"Mirzayev","year":"2023","journal-title":"Photodiagnosis Photodyn. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1667","DOI":"10.1001\/archopht.1979.01020020235011","article-title":"Pigmentary Dispersion and Glaucoma: A New Theory","volume":"97","author":"Campbell","year":"1979","journal-title":"Arch. Ophthalmol."},{"key":"ref_10","unstructured":"(2024, October 02). Current Issue: Current Opinion in Ophthalmology. Available online: https:\/\/journals.lww.com\/co-ophthalmology\/pages\/currenttoc.aspx."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1159\/000443697","article-title":"What\u2019s in a Gene Pseudoexfoliation Syndrome and Pigment Dispersion Syndrome in the Same Patient","volume":"7","author":"Pokrovskaya","year":"2016","journal-title":"Case Rep. Ophthalmol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/6\/758\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:55:45Z","timestamp":1760028945000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/6\/758"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,18]]},"references-count":11,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["diagnostics15060758"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15060758","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2025,3,18]]}}}