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CASE REPORT
Year : 1988  |  Volume : 36  |  Issue : 4  |  Page : 182-183

Conjunctival cyst after retinal detachment surgery


Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India

Correspondence Address:
S P Garg
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029
India
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Source of Support: None, Conflict of Interest: None


PMID: 3253216

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  Abstract 

A case of implantation cyst of the conjunctiva follow ing retinal detachment surgery is reported


How to cite this article:
Garg S P, Verma L, Khosla P K. Conjunctival cyst after retinal detachment surgery. Indian J Ophthalmol 1988;36:182-3

How to cite this URL:
Garg S P, Verma L, Khosla P K. Conjunctival cyst after retinal detachment surgery. Indian J Ophthalmol [serial online] 1988 [cited 2020 Apr 5];36:182-3. Available from: http://www.ijo.in/text.asp?1988/36/4/182/26115


  Introduction Top


Conjunctival cysts can arise spontaneously [1],[2] or occur following trauma [3],[4], infection , or surgery [6],[7]. Conjunc­tival cysts following retinal detachment surgery are rare; we are aware of only three reported cases to date.

We present one case of conjunctival cyst following routine surgery for retinal detachment.


  Case Report Top


A 45-year-old lady had decreased vision in her left eve due to a total rhegmatogenous retinal detachment. Under local anaesthesia, after appropriate blocks, a 360° limbal peritomy was performed with radial relaxing incisions at 10 and 4'O clock positions. Cryopexy was done at 11 and 1'O clock and' a solid silicone grooved explant was placed with an encircling band. After drainage of subretinal fluid the retina settled on the buckle. The conjunctiva and Tenon's capsule were reapproximated at the limbus with 6-o chromic catgut sutures, with additional sutures in two separate layers along the relaxing incisions.

The patient was asymptomatic until one year later, when she complained of a foreign body sensation in her left eye. Examination revealed a translucent, round nontender, cystic lesion in the bulbar conjunctiva at 5'O clock.

Under topical 4% xylocaine anethesia, the cyst was excised. Conjunctiva and Tenon's capsule were care­fully dissected from the surface and sides of the lesion. The 10mm x 12mm cystic mass was removed entirely [Figure - 1]. There was no communication of the cyst with intraocular structures. The Tenon's capsule and the remaining conjunctiva were closed. When last seen, six months after cyst removal, the patient was asymptomatic with no recurrence.

Histology showed the cyst lining to be of non-keratiniz­ing stratified epithelium [Figure - 2] with goblet cells, consistent with the diagnosis of a conjunctival implan­tation cyst.


  Discussion Top


Conjunctival complications following surgery for retinal attachment include symblepharon, granuloma and im­plantation cyst [8]. While the former two have been well documented, conjunctival cysts rarely have been reported.

The origin of these cysts is not entirely clear, but various mechanisms have been proposed. In his case report of a cist following surgery for retinal detach­ment, Ascott stated that implantation of epithelium probably occurred while drawing a conjunctival suture through deeper tissues. McCarthy and co-workers7 suggested that a tongue of conjunctiva may be inad­vertently incarcerated into a wound closure thus ex­posing a conjunctival edge to deeper tissues. Once conjunctival epithelium gains access, it could then proceed to line Tenon's capsule and the episclera. Another mechanism for cyst formation may be an epithelial downgrowth. Dryden and Leibsohn showed that epithelium can grow down from the conjunctival surface to line Tenon's capsule, surrounding implants following enucleation [10]. Whatever the mechanism, viable epithelium gains access to, and probably lines the underlying ocular tissues. According to Parson", the cysts, growing by the secretion of inverted epithelial cells as well as by the degeneration and desquamation of the innermost cells, often become quite large.

Although three reports [8],[12],[13] exist of large conjunctival cysts following retinal detachment surgery, the true incidence of implantation cysts is not known. The reason for this could be the small size of these cysts, absence of any symptoms or rarity of occurence. Although we have been performing surgery for retinal detachment for over 15 years, this is our first encounter of a patient who presented with a conjunctival cyst.

 
  References Top

1.
Srinivasan BD, Jakobiec FA, Iwamoto T et al. Epibulbar mucogenic subconjunctival cysts. Arch Ophthalmol, 96:257-59, 1978.  Back to cited text no. 1
    
2.
Ebert RO. Large retention cyst of the conjunctiva. Am J Ophthalmol, 16:900, 1933.  Back to cited text no. 2
    
3.
Wolff EA. Large implantation cyst of the conjunctiva. Proc Royal Soc Med, 22:4-6,1928.  Back to cited text no. 3
    
4.
Perkins EW. Implantation cyst of the conjunctiva. Am J Ophthalmol, 35:196-98, 1952.  Back to cited text no. 4
    
5.
Kiffney GT Jr. Large conjunctival cysts, a report of three cases. Am J Ophthalmol, 54:458-61, 1962.  Back to cited text no. 5
    
6.
Judisch GE, Maumenee IH Large orbital, conjunctival cyst after enucleation. Am J Ophthalmol, 23:49-51, 1977.  Back to cited text no. 6
    
7.
McCarthy RW, Beyer CK, Dallow RL et al, conjunctival cysts of the orbit following enucleation. Ophthalmology, 88:3-35, 1981.  Back to cited text no. 7
    
8.
Schepens CL. Postoperative complications : I. Problems common to most procedures, in Retinal Detachment and allied diseases. Philadelphia W.B. Saunders, Vol 2, 989, 1983.  Back to cited text no. 8
    
9.
Ascott JR. Implantation cyst following operation for detachment of the retina. Br J Ophthalmol, 26:126-28, 1942.  Back to cited text no. 9
    
10.
Dryden R, Leibsohn J Post-enucleation orbital implant extrusion. Arch Ophthalmol, 96:2064-65, 1978.  Back to cited text no. 10
    
11.
Parsons. Pathology of the Eye. Putnam, New York, 1905.  Back to cited text no. 11
    
12.
Rosenquist RC, Fraunfelder FT, Swan KC. Treatment of conjunctival epithelial inclusion cysts with trichloreacetic acid. J. Ocular Ther Surg, 4:51-53, 1985.  Back to cited text no. 12
    
13.
Newton JC, Pruett RC, Merhige KE, Moris PJ. Giant cysts of the Conjunctiva following scleral buckling. Ophthalmic Surg, 18:295-98, 1987.  Back to cited text no. 13
    


    Figures

  [Figure - 1], [Figure - 2]



 

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