Epithelial cyst of the iris following penetrating keratoplasty.

Abstract

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

Graft failure: III. Glaucoma escalation after penetrating keratoplasty

“…Complication of PKP include graft rejection or failure, graft dehiscence, infection, flat anterior chamber, pupillary block, synechial angle closure, aqueous misdirection, hyphema, cataract, retinal detachment, choroidal effusion, suprachoroidal hemorrhage, and endophthalmitis [17][18][19][20][21][22][23][24][25][26][27]. One of the more common complications after PKP is the development of glaucoma, which may occur either early or late postoperatively [28][29][30][31][32][33][34][35].…”

Implantation Cyst of Anterior Chamber: A Case Report

“…Echolucent cysts are always unilateral and are usually located in the iris or ciliary body stroma. They tend to have large diameters that cause iris atrophy by compression, as seen in this case [ 11 ]. In a retrospective chart review, Marigo et al [ 9 ] reported that most cystic lesions were not septate.…”

An Iris Tumor

“…1 The debris material was whitish in color and could been seen on gonioscopy through the epithelial lining of the cyst (Figure 1B), and the fluid-debris level may represent serous material with free iris epithelial cells. 8 Occasionally, iris stromal cysts have been known to regress spontaneously. 9 Diathermy, electrolysis, aspiration followed by injection of absolute alcohol, and surgical excision with or without adjunctive cryotherapy and laser photocoagulation are therapeutic approaches that have been described should an iris stromal cyst become symptomatic.…”