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

Abstract

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.

Surgical Treatment of a Corneal Epithelial Cyst

“…Unless the entire cyst is removed, remnants lined with living cells often remain at the junction between the donor and virgin corneas after keratoplasty, which may increase recurrence of the cyst involving the virgin cornea. 8 In our case, distilled water rather than a chemical solution was injected into the corneal cyst cavity, involving the visual axis, to destroy the epithelial cells in the cavity by osmolysis and to minimize postoperative corneal damage and opacity. Postoperatively, the presence of small white granular opacities in the interface, presumably epithelial cell nests, suggests that distilled water injection into the cavity of the corneal cyst cavity does not entirely eliminate the epithelium in the cavity.…”

“…Unless the entire cyst is removed, remnants lined with living cells often remain at the junction between the donor and virgin corneas after keratoplasty, which may increase recurrence of the cyst involving the virgin cornea. 8…”

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

“…Previously suggested irrigation solutions include 10% acetic acid, 1% iodine, cocaine, 5-fluorouracil, 20% trichloroacetic acid, 96% ethanol, distilled water, and balanced salt solution. 2 , 7 , 10 The authors present a case of an intrastromal cyst successfully treated with surgical drainage, curettage, and distilled water irrigation.…”

Traumatic corneal cyst

“…[1] As simple drainage of the cyst have been associated with recurrence of the fluid accumulation, chemical cauterization with distilled water, 5-fluorouracil, ethanol and trichloroacetic acid have been utilized to prevent recurrence in mid stromal cysts. [23] OCT-guided chemical cauterization and penetrating keratoplasty are the treatment options for recurrent deep stromal visually significant intracorneal cysts. [4]…”