Long-term results of surgical excision of conjunctival retention cyst using trypan blue with methylcellulose

A Case of Conjunctival Cyst Required Removal Six Months After Strabismus Surgery

A conjunctival cyst is a rare yet significant complication following strabismus surgery. This report describes a nine-year-old girl who developed a conjunctival cyst after undergoing bilateral lateral rectus recession surgery for intermittent exotropia. Despite an uneventful surgery and standard postoperative care, she presented with a gradually enlarging subconjunctival mass in the left eye three months later. Initial conservative treatment with topical antibiotics and steroids proved ineffective, leading to surgical excision six months postoperatively. Histopathological examination confirmed the cyst as a conjunctival epithelial inclusion cyst, characterized by cuboidal epithelium containing goblet cells. The patient's postoperative course was uneventful, with no recurrence of the cyst at six months follow-up, stable visual acuity, and maintained strabismus correction. In managing this case, two crucial lessons were learned. Firstly, the need for precise surgical techniques and the use of adequate pre- and intraoperative disinfection measures to prevent postoperative complications. Ensuring that the conjunctival tissue is not inadvertently included in the wound closure and maintaining a sterile environment throughout the surgery are critical steps. Secondly, the importance of early recognition and timely intervention for postoperative complications. The patient's cyst developed three months post-surgery and did not respond to conservative treatments, necessitating surgical excision. This reinforces the need for heightened awareness and prompt surgical intervention when conservative measures fail, ensuring optimal patient outcomes and avoiding unnecessary discomfort or cosmetic issues. In conclusion, meticulous surgical technique and proper pre- and intraoperative disinfection are paramount in preventing postoperative complications such as conjunctival cysts. Early recognition and timely surgical intervention are essential for managing these cysts effectively. This case reinforces the importance for ophthalmic surgeons to remain vigilant in their surgical practices and to promptly address any postoperative complications, thereby improving surgical outcomes and enhancing patient care in strabismus surgery.

Clinical characteristics and surgical outcomes of transcutaneous versus transconjunctival excision of Wolfring gland ductal cysts

PURPOSE

To analyze the clinicopathological characteristics and surgical outcomes of patients with Wolfring gland ductal cysts (WGDCs).

METHODS

A retrospective, consecutive, interventional comparative case series was performed over a period of 7 years. Data on demographic and clinical characteristics, pathological findings and outcomes of surgically excised cysts were collected. A comparison between the transconjunctival and transcutaneous approaches was also assessed.

RESULTS

Forty-eight patients (48 eyelids) were included in the final analysis. The most common presenting symptom was painless eyelid swelling (81.3%). The median symptom duration was 11.5 months (IQR, 18.25). The upper eyelid was involved in 31 (64.6%) patients, 29/31 of whom had cysts in a medial or centromedial location. Forty-five (93.8%) cysts were bluish gray and transilluminable with clear contents on lid eversion and a median largest dimension of 22 mm (IQR, 8). A transverse conjunctival fibrotic band was observed along the proximal tarsal border in the cyst area in all patients. Signs of chronic trachoma were noted in 38 (79.2%) patients. Preoperative significant ptosis was present in 28/31 (90.3%) of the upper eyelid cysts. Thirty cysts (62.5%) were excised through the skin, and 18 cysts (37.5%) were excised transconjunctivally. Intraoperative cyst rupture, the need for conjunctival grafting and postoperative residual upper lid ptosis were significantly greater in the transconjunctival group (p = 0.009, p < 0.001, and p = 0.016, respectively).

CONCLUSION

The present study highlights the clinicopathological characteristics of a relatively large series of surgically excised WGDCs. Transcutaneous excision of WGDCs has proven to be an effective treatment with fewer adverse sequelae than the transconjunctival approach.

How to reduce conjunctival cyst formation after strabismus surgery?

PURPOSE

To determine our rate of conjunctival cyst developing after strabismus surgery and to minimize its formation.

MATERIALS AND METHODS

The data of 4026 eyes of 2662 patients were included in our retrospective analysis of, those that underwent strabismus surgery at the Beyoğlu Eye Training and Research Hospital Strabismus Unit between 2015 and 2021. Clinical characteristics and follow-up data of patients were recorded together with age, sex, and operation type. All patients were examined postoperatively on 1st day, 1st month and 6th month.

RESULTS

The mean age of the patients was 15.66 ± 11.81 (1-59 years). While two eyes were operated on in 1494 patients, one eye was operated on in 1168 patients. The surgeries performed were recession and/or resection of the horizontal and vertical rectus muscles and inferior and superior oblique procedures. The conjunctival cyst was detected in 11 patients postoperatively between 20 days and 8 months. The cyst was detected on the nasal side in 7 cases and temporal in 4.

CONCLUSION

Conjunctival cyst is a rare complication after strabismus surgery and it is thought to be caused by a proliferation of the conjunctival epithelium. In addition to proper closure of the conjunctiva, attention to personal hygiene, avoidance of contacts that may increase suture contamination, and attention to the fact that the operation period is not long are actions that can help prevent conjunctival cyst formation.

A Novel Approach to Treatment of Conjunctival Cyst Ablation Using Atmospheric Low-Temperature Plasma

Purpose

Introducing a new technique to remove the conjunctival cyst using atmospheric low-temperature plasma (ALTP) and assessing its effectiveness.

Patients and Methods

Five eyes with conjunctival cysts were included in this study. The procedure was started by applying a plasma spot on the highest point of the cyst, and then other spots were spirally applied to the base of the cyst to debulk it. The conjunctival cysts were removed using the white handpiece of the plasma generator device (Plexr, GMV s.r.l Grottaferrata, Italy). Refraction, visual acuity, intraocular pressure (IOP), contrast sensitivity (CS), aberrometry, dry eye tests, and ocular surface disease index (OSDI) questionnaire were measured before, one and six months after treatment.

Results

The mean size of the cysts was 3.6 mm (range 2.1 to 4.8 mm). No intraoperative and postoperative complications were observed. Postoperative examinations showed that the patients’ cysts were completely healed and recurrence did not occur. Significant changes in visual parameters, IOP, CS, aberrometry and dry eye tests were not observed in the follow-up periods after treatment compared to before. OSDI score decreased after cyst removal.

Conclusion

Our recommended technique using ALTP can be used as a new approach to treating conjunctival cysts. This technique is a simple, office-based, minimally invasive, effective and inexpensive way to remove a cyst.