Anterior Chamber Epithelial Cyst After Uneventful Deep Anterior Lamellar Keratoplasty

Implantation iris cysts developing 24 years after penetrating keratoplasty

PURPOSE

To report a case of iris implantation cysts occurring 24 years after penetrating keratoplasty and its management.

OBSERVATIONS

A 60-year-old man was referred for diagnosis and management of white iris masses of the right eye. He had undergone bilateral penetrating keratoplasty 24 years before without complication. The clinical findings were suggestive of iris implantation cysts and Ultrasound Biomicroscopy (UBM) and anterior-segment optical coherence tomography confirmed the diagnosis. The patient did not develop any ocular complications from the cysts after one-year follow-up from the diagnosis of iris implantation cysts.

CONCLUSIONS AND IMPORTANCE

Iris implantation cysts are rare benign tumors that develop after the ectopic implantation of epithelial cells within the iris stroma. They can be congenital or secondary to penetrating trauma or surgery. Their diagnosis relies on clinical examination and UBM. In case of intraocular complications, treatment may be required, otherwise observational follow-up is appropriate.

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

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.

Corneal epithelial inclusion cysts in 12 dogs (13 eyes) from 2010 to 2019: A multicentric retrospective study

OBJECTIVE

The aim of this retrospective study was to review the clinical data and outcomes of patients that suffered corneal epithelial inclusion cysts (CEIC). Animals studied Thirteen eyes from 12 dogs from multiple private practices in France and Belgium, with a strong clinical of CEIC were included in the study.

RESULTS

The mean age of affected dogs was 9 years. There were 9 females and 3 males. Two out of 12 dogs were Shih Tzus. Where identified, etiology was traumatic. Eleven dogs were affected unilaterally, 1 bilaterally. The cysts were single, bi-lobulated, or tri-lobulate, and cyst size ranged from 1 to 6 mm in diameter. Keratectomy alone was performed in seven cases, in conjunction with a conjunctival graft in three cases, a porcine small intestine mucosa graft in two cases, or an amniotic membrane graft in one case. Histopathologic findings were consistent in all eyes with a cyst located in the corneal stroma, composed of a nonkeratinized squamous epithelium delineating a lumen filled with neutrophils and desquamated epithelial cells. Surgery was curative in all cases but one, where the removal was incomplete and recurrence occurred several weeks after the surgery.

CONCLUSION

Corneal epithelial inclusion cysts is a rare condition, secondary to corneal trauma, which can be treated successfully with conventional keratectomy alone or in conjunction with graft procedures.

Iris cysts: A comprehensive review on diagnosis and treatment

Iris cysts, both primary and secondary, are a diagnostic and treatment challenge. Primary cysts arise either from the iris pigment epithelium or the iris stroma. Posterior pigment epithelial cysts are subdivided according to their location as central, midzonal, and peripheral. Iris stromal cysts are classified either as congenital or acquired. Free-floating cysts are usually dislodged pigment epithelial cysts. Secondary cysts are classified according to the underlying cause as implantation cysts, drug-induced, uveitic, tumor-induced, parasitic, or as cysts associated with systemic disorders. Differential diagnosis is based on the clinical presentation and imaging. Ultrasound biomicroscopy is the gold standard for the imaging of iris cysts, combining excellent resolution with sufficient tissue penetration. Treatment of iris cysts depends largely on whether they become symptomatic or not. Symptoms include obstruction of the visual axis, corneal decompensation, secondary uveitis, and secondary glaucoma. Treatment options cover a range from simple observation to fine-needle aspiration (with or without intracystic injection of absolute alcohol or antimitotic agents), laser (argon, Nd:YAG), or surgical excision. In the past, the prevailing notion was that of a radical surgical intervention in the form of iridectomy or iridocyclectomy. Given the high rate of recurrence, a stepwise conservative approach is currently favored by most clinicians.

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

Background

Intracorneal 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 presentation

This 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.

Conclusion

When 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.