Corneoscleral cyst treated with distilled water injection

Abstract

To describe the first case of the treatment of a corneoscleral cyst by distilled water injection into a corneal cyst. The anterior wall of a cyst of the limbal communication was punctured with a surgical blade. Aspiration and irrigation of the contents of the cyst with a 27-gauge anterior chamber cannula were performed repeatedly, three times. Distilled water, instead of balanced salt solution, was injected into the collapsed cyst, and was then aspirated completely after 5 minutes. The injection and aspiration of distilled water was repeated once more. The scleral cyst was surgically excised. Twelve months after surgery, several small white granular opacities, presumably epithelial cell nests, were observed on the interface of the collapsed cyst cavity, but there was no recurrence of the cyst. The best spectacle-corrected visual acuity (BSCVA) was 1.0 with a correction of +1.25-2.00 X 45. No significant change in central corneal endothelial cell density was noted. We suggest that this simple technique may represent an alternative method for the management of corneal cysts, and may have less risk of developing a corneal opacity or causing other serious damage to surrounding tissues.

Utilization of Distilled Water Lavage for Localized Fluid Collection After Combined Hepatectomy and Cyst Fenestration for Polycystic Liver Disease

“…To the best of our knowledge, there have not been any reports regarding use of distilled water as a sclerosant other than the Shin's report. 8 We believe that 2-year relief of symptoms of PLD in the present case was a result of our choice of distilled water as a sclerosant. In addition, we consider that the appropriateness of our choice is supported by the fact that fenestrated cysts and TLV in the present case continued to decrease up to 1 year after surgery and thereafter retained less than one-third of the preoperative volume.…”

“…[5][6][7] Thus, we decided to apply DWL via percutaneous drainage tube to this condition as a sort of sclerotherapy. 8 Ethanol is commonly used as a sclerosant of sclerotherapy for liver cysts. 16 However, ethanol was considered too strong and rather harmful if exposed to the cut surface of the liver and thus we decided to use distilled water.…”

“…Use of DWL for the present case was approved by the Ethics Committee of the Yokohama Ekisaikai Hospital because its use was considered in accordance with the ethical guidelines for epidemiologic research in Japan based on previous reports regarding use of DWL in clinical settings. [8][9][10][11][12][13] A 63-year-old postmenopausal woman with PLD developed severe abdominal fullness and edema of lower extremities. Her PLD was not accompanied by polycystic kidneys because no cystic lesions were found in her kidneys.…”

“…Furthermore, total liver volume (TLV), including an area where massive localized fluid collection treated with DWL existed, continued to reduce up to 12 postoperative months and thereafter retained less than one-third of preoperative volume more than 2 years after surgery. Sustained reduction of TLV suggested a sclerosant effect of hypotonic cytocidal property of distilled water for cyst endothelium 8 and/or retrieved effectiveness of fenestration. Hence, we consider this approach to be useful for patients with PLD receiving CHCF, and thus present it here.…”

Enlarging corneoscleral cyst in a 2-year-old girl

“…The in vivo dose-effect of sterile water on cystic lining survival is not completely validated, and we irrigated for 5 minutes as recommended by Shin and colleagues. 1 Combined with this technique, we also brought the two apposing surfaces of the scleral cyst walls together with closely lined sutures, as described by Bhatt and Ramaesh. 3 Lamellar keratoplasty was not appropriate in the present case but could be helpful in select cases.…”