Management of an intrastromal corneal epithelial cyst, from simple drainage to keratoplasty

Zare, Mohammad; Mehrjardi, Hadi Z.; Golabdar, M R

doi:10.4103/0974-620x.106107

Cited by 10 publications

(18 citation statements)

References 9 publications

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“… Author Year Journal Patient Demographics Size of Cyst Stromal Layers Involved Etiology of Cyst Management Outcome Bloomfield et al 6 1980 American Academy of Ophthalmology 5yo M 2–3 mm Posterior third of the corneal stroma Ocular trauma from wire cable PK Graft failure at POM 3 Dhiman et al 18 2015 BMJ Case Reports 11yo M 4 × 4.2 mm Mid- to posterior stroma Suture removal following PK 1) Cyst aspiration with chemo-cytodestruction of the cyst cavity with povidone iodine 1% 2) Focal anterior stromal flap lift, deep lamellar dissection to excise the stroma containing the recurrent cyst, and donor corneal stromal lenticule lamellar placement beneath the flap and suturing of the flap Small recurrence 1.5 years after last surgery. Mifflin et al 2 2001 Cornea 5yo F 4–5 mm Mid- to deep stroma Iatrogenic seeding of corneal stroma from limbal traction suture (prior strabismus surgery) Cyst incision and debridement No recurrence at POM 21 Zare et al 3 2012 Oman Journal of Ophthalmology 10yo F 5 × 8 mm, progressing to 6 mm × 10 mm at 2-year follow-up after first operation Anterior to deep stroma, near Descemet's membrane Unknown Multiple surgical interventions: 1) Cyst drainage, debridement, and mechanical curetting of the cyst wall through a 2.0mm partial-thickness limbal incision. 2) LK complicated by perforation of posterior corneal lamella, and subsequently converted to PK.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…However, in cases of progressively enlarging cysts that threaten the visual axis, interventions ranging from simple drainage to cyst wall excision to lamellar or penetrating keratoplasty (PK) may be required. 3 Methods to prevent cyst formation include cryotherapy prior to PK and irrigation of any accidently implanted epithelial cells after PK. Repeated irrigation of the corneal bed following cyst removal may also help to prevent entrance of epithelial cells into the anterior chamber, and reduce the risk of cyst recurrence.…”

Section: Introductionmentioning

confidence: 99%

“…Repeated irrigation of the corneal bed following cyst removal may also help to prevent entrance of epithelial cells into the anterior chamber, and reduce the risk of cyst recurrence. 3 …”

Section: Introductionmentioning

confidence: 99%

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Trans-stromal epithelial cyst after multiple lamellar keratoplasties - Case report and review of literature

Chen

Nowroozizadeh

Kedhar

et al. 2020

American Journal of Ophthalmology Case Reports

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Design Single Observational Case Report. Setting A 67-year-old male of Persian descent had a complex systemic and ocular history prior to a right penetrating keratoplasty (PK) reported here. The clinical diagnoses leading to the PK included Cogan's syndrome, chronic uveitis, secondary glaucoma, and corneal stromal scarring, presumed secondary to a corneal ulcer diagnosed on the second visit to our clinic. The specimen described here had been in place for 11 months and 17 days after the third failed Descemet stripping endothelial keratoplasty (DSEK). Visual acuities had ranged from 20/100 to 20/400 in both eyes. Visual acuity in the right eye just before surgery was 20/400. Intraocular pressures were 22 mmHg in both eyes with functioning Ahmed glaucoma shunts. The stromal cyst was not suspected preoperatively and no clinical imaging was performed. Study Methods Histopathology including serial sections and immunohistochemistry. Results Histologic study demonstrated a trans -stromal corneal epithelial cyst without goblet cells that extended through a 500 μm gap in the donor tissue surface and edge. Conclusions This large stromal cyst was an unusual complication of serial posterior lamellar keratoplasties and we postulate that multiple prior posterior lamellar grafts may have been a risk factor for this complication. Anterior segment imaging with either anterior segment optical coherence tomography or high-resolution ultrasound would likely have detected this stromal cyst.

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Section: Discussion/conclusionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Trans-stromal epithelial cyst after multiple lamellar keratoplasties - Case report and review of literature

Chen

Nowroozizadeh

Kedhar

et al. 2020

American Journal of Ophthalmology Case Reports

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show abstract

“…As the severity of chemical ocular injury is related to the surface of contact in chemical exposure and the degree of penetration, the potential ocular complications of TCA like epithelial defects, corneal scarring and chemical uveitis, could be minimized by careful manipulation and thorough irrigation. Chemical cauterization using 20% TCA is known to prevent epithelial survival, although it can lead to scar formation [ 1 ]. Since we did not know what was a safe concentration of TCA for preserving endothelial cells that are located very close to the cystic wall, we initially applied low-strength (2.5%) TCA.…”

Section: Discussionmentioning

confidence: 99%

“…Lamellar keratoplasty is another treatment option for the epithelial cyst removal when the cyst is not deep. A deep cyst close to the endothelium can convert to penetrating keratoplasty, however, due to perforation during lamellar keratoplasty [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Portable OCT-assisted surgical treatment of intracorneal pre-Descemet epithelial cyst: a case report

Kim

2017

BMC Ophthalmol

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BackgroundIntracorneal epithelial cysts are a rare clinical condition that can occur anywhere in the corneal tissue; however, they appear most commonly in the stroma. They are sometimes challenging to treat because of their location, depth, and visual outcomes. Herein, we report a pre-Descemet epithelial cyst that was successfully treated surgically, with guidance from Fourier-domain optical coherence tomography (FD-OCT).Case presentationThis interventional case report presents a patient with gradually decreasing vision caused by a pre-Descemet epithelial cyst. A 4-year-old girl with no history of trauma or ocular surgery showed a deep-seated intracorneal cyst in her left eye (8 o’clock corneoscleral area, dissecting into the pre-Descemet cornea). The cyst was threatening the visual axis. An epithelial cyst was diagnosed after drainage on the basis of the cyst contents. We irrigated inside the cyst using 10% trichloroacetic acid (TCA), distilled water, and 1% 5-fluorouracil (5-FU) solutions for chemical cyto-destruction of the lining epithelial cells of the cystic wall. We used a portable FD-OCT during operation to guide this procedure, without perforating the Descemet’s membrane and endothelial layer. Recurrence could be prevented after removal of the cystic tissue located in the sclera area outside of the limbus. No recurrence was noted during the 4-year follow-up.ConclusionWhen treating centrally deep-seated intracorneal epithelial cysts, clinicians must consider recurrence, endothelial damage, and visual outcome. Herein we report the case of a deep-seated, intracorneoscleral epithelial cyst that was completely resolved with chemical cyto-destruction and removal of the intrascleral cystic tissue under the guidance with FD-OCT; thus, endothelial damage could be minimized.

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Surgical excision and distilled water lysis of a congenital corneal intrastromal cyst

Little

See

2020

American Journal of Ophthalmology Case Reports

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Purpose To describe imaging findings and encourage the use of distilled water as an adjuvant osmolytic in the surgical management of corneal intrastromal cysts. Observations A five-year-old female with no history of ocular trauma presented with a visually significant corneal opacity of the left eye. She was diagnosed with a presumed corneal intrastromal cyst and underwent surgical excision with distilled water osmolysis of the cyst cavity. Conclusions and Importance Optical coherence tomography (OCT) can confirm diagnosis of intrastromal cysts. Presumed epithelial cell nests remain visible at post-operative month eight, with no evidence for cyst recurrence. The authors propose that OCT findings are pathognomonic for corneal intrastromal cysts and that cyst excision combined with distilled water osmolysis at the time of debridement may be beneficial in conserving tissue integrity.

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Management of an intrastromal corneal epithelial cyst, from simple drainage to keratoplasty

Cited by 10 publications

References 9 publications

Trans-stromal epithelial cyst after multiple lamellar keratoplasties - Case report and review of literature

Trans-stromal epithelial cyst after multiple lamellar keratoplasties - Case report and review of literature

Portable OCT-assisted surgical treatment of intracorneal pre-Descemet epithelial cyst: a case report

Surgical excision and distilled water lysis of a congenital corneal intrastromal cyst

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