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SUMMARY In a 35-year-old patient with keratoconus a cyst of the iris was first observed 22 months after routine penetrating keratoplasty. The lesion was completely excised and shown by light and transmission electron microscopy to be composed of conjunctival epithelium organised as a single large cyst containing serous material and occasional free epithelial cells. The management of epithelial implantation cysts is discussed. When indicated, complete surgical excision without rupture is preferred to avoid possible intraocular dissemination of viable epithelial cells that might result in further complications.Aberrant epithelium in the ocular anterior chamber is a well recognised complication of accidental and surgical perforating wounds of the cornea. Epithelialisation involving the iris may develop as (1) solid (pearl) tumours, (2) serous cysts, (3) epithelial implantation membranes, or (4) epithelial ingrowth.12 Although each type of epithelial invasion shows different growth characteristics, all have a potential for progression, which in some cases can be rapid and extensive, resulting in visual obstruction, iridocyclitis, secondary glaucoma, and potential loss of the eye.'2 The decision to intervene surgically is predicated on documented progression of the lesion and knowledge of its potential dangers. The preferred method of treatment must be based on the site affected and anticipation of the behaviour of the lesion.We observed the occurrence and progression of a cystic lesion of the iris following penetrating keratoplasty. Treatment by excision provided the first histopathological specimen to be examined by transmission electron microscopy. Case reportA 35-year-old Caucasian male required penetrating keratoplasty for keratoconus. His eye was otherwise normal. Penetrating keratoplasty was performed on the left eye without apparent complication, with continuous 10-0 nylon suture placed at midstromal