Treatment of an 8-mm Myxoma Using Acellular Corneal Tissue

Abstract

A myxoma is a benign tumor found in the heart and in various soft tissues; however, a corneal myxoma is rare. A mucinous mass of unknown etiology was observed on the left cornea of a 32-year-old male patient. We performed deep anterior lamellar keratoplasty using acellular corneal tissue and concurrent amniotic membrane transplantation. Hematoxylin and eosin staining revealed vacuolation of the parenchyma and myxoid change in the corneal tissue that occurred in the anterior half of the corneal parenchyma. We identified a myxoid stroma by Alcian blue staining and observed collagen fibers with denatured stroma by Masson trichrome staining. The patient's visual acuity improved from light perception to 20 / 200, and the intraocular pressure remained within the normal range for one year after surgery. The transplanted cornea survived successfully with well-maintained transparency, and recurrence was not observed one year after surgery.

Clinical features and histopathological analysis of corneal myxoma

“…One eye had to be removed, one case experienced recurrence, and one eye experienced graft failure. The histological findings of the current study on corneal myxoma concur with previous literature 5 , 7 , 10 .…”

“…Since our cohort included cases with histologically confirmed corneal myxoma, we could not report how many were clinically suspected, however, no preoperative diagnosis of myxoma was documented in the files of all cases until a histopathology report was presented. Clinically suspect corneal myxoma needs to be differentiated from nodular fasciitis, Salzmann’s nodular degeneration, foreign body reaction, pannus, corneal amyloid, contact lens-induced epithelial microcysts or corneal pseudocysts, corneal keloid, dermoid tumor, corneal squamous cell carcinoma and sarcoma 5 , 7 , 10 . In many cases, it is confirmed following excision and histological review as in the current study.…”

“…Alternately, it has been suggested that the disruption of Bowman’s layer may be an important factor in the development of secondary corneal myxoma, which was a consistent observation in all our cases 6 . Corneal myxomas tend to form anteriorly beneath the epithelium 10 . In our cases, the myxomas were all subepithelial and the epithelial changes were variable in different specimens but shared the presence of epithelial edema in 9 out of 10 cases.…”

Secondary Corneal Myxoma After DMEK (Descemet Membrane Endothelial Keratoplasty)

“…Primary corneal myxomas are extremely rare and affect young people under the age of 15 years old, with no particular clinical background. On the other hand, most of corneal myxoid lesions occur in patients who have previously developed a corneal lesion such as traumatic or infectious corneal ulcers or keratoconus, or after a surgical treatment such as cataract surgery, keratoplasty, or photorefractive keratectomy [1–5,8–14] (See Table 1 [8–22]).…”

“…The treatment of secondary myxomas consists of a surgical excision of the lesion, normally without recurrence. Surgery can be limited to the tumor, or it can include a reconstruction by penetrating keratoplasty or anterior lamellar graft keratoplasty, which seems to lead to satisfactory results [14]. To our knowledge, pharmacological treatments, including topical treatments, are not effective for this kind of lesion.…”