Anterior Chamber Epithelial Cyst After Uneventful Deep Anterior Lamellar Keratoplasty

Costa, José Ferreira; Rêgo, Marco Antônio Vasconcelos; Rosa, Andreia; Costa, Esmeralda; Fonseca, Pedro; Cachulo, Maria da Luz; Veríssimo, Júlia; Quadrado, José Carlos; Murta, Joaquim

doi:10.1097/ico.0000000000000866

Cited by 7 publications

(8 citation statements)

References 7 publications

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“…Sheets covering the endothelial surface, angle structures and iris surface rarely extending through the pupil into the vitreous; 2. cysts expanding into the anterior chamber from inadequately closed wounds; and 3. iris pearl tumors. 4 Intracorneal cysts may follow ocular trauma 5 , 6 , 7 and prior ocular surgeries including keratoplasty (both penetrating and lamellar), 8 , 9 , 10 glaucoma surgeries, 11 and strabismus surgeries. 2 , 12 Stromal cysts have reportedly ranged from 2 mm to 9 mm in diameter, occupying one or more lamellar planes ( Table 1 ).…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…Proposed mechanisms for stromal cyst formation include epithelial migration into the anterior chamber through a limbal paracentesis or stromal puncture. 4 , 9 , 13 Injuries to the limbus, such as those associated with limbal paracentesis or needle used to place a traction suture, can also allow epithelial cell entrance into the anterior chamber. 12 Sequestration of these cells in the stroma and their subsequent proliferation likely account for cyst growth.…”

Section: Discussion/conclusionmentioning

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: Discussion/conclusionmentioning

confidence: 99%

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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“…5 Another report described a case of an anterior chamber epithelial cyst occurring after uncomplicated DALK that was treated with a tissue-sparing surgical technique. 9 Although DALK is associated with Correspondence long-term follow-up and use of local eye drops, it is advisable to use keratoplasty in refractory corneal cysts with deep stromal extension and visual axis involvement to both eradicate the cyst and achieve a better visual outcome.…”

Section: Discussionmentioning

confidence: 99%

Deep anterior lamellar keratoplasty for an intrastromal epithelial corneal cyst: a case report

Zhang

Pan

2018

Canadian Journal of Ophthalmology

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“…In such cases, recurrence involving the virgin cornea might be plausible. When deep lesions are involved, any tiny perforation might induce the epithelial lining of the cyst to migrate into the anterior chamber [ 12 ]. For these reasons, it is crucial that surgeons completely eliminate cystic epithelial cells before performing lamellar or penetrating keratoplasty if they exist at the border between donor and virgin corneas.…”

Section: Discussionmentioning

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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Anterior Chamber Epithelial Cyst After Uneventful Deep Anterior Lamellar Keratoplasty

Abstract: An anterior chamber epithelial cyst is a sight-threatening condition that may occur after DALK. In selected cases, a conservative surgical approach is an effective treatment option, conveying excellent functional and anatomical outcomes.

Cited by 7 publications

References 7 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

Deep anterior lamellar keratoplasty for an intrastromal epithelial corneal cyst: a case report

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

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