Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 314
  • Home
  • Print this page
  • Email this page

   Table of Contents      
LETTER TO THE EDITOR
Year : 2011  |  Volume : 59  |  Issue : 3  |  Page : 257-259

Excision of post small incision cataract surgery conjunctival inclusion cyst


Department of Ophthalmology, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India

Date of Web Publication13-May-2011

Correspondence Address:
Shreya Thatte
"Chaitanya" 17, Yeshwant Colony, Behind Sita Building, Indore, Madhya Pradesh - 452 003
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.81028

Rights and Permissions

How to cite this article:
Thatte S, Gupta L. Excision of post small incision cataract surgery conjunctival inclusion cyst. Indian J Ophthalmol 2011;59:257-9

How to cite this URL:
Thatte S, Gupta L. Excision of post small incision cataract surgery conjunctival inclusion cyst. Indian J Ophthalmol [serial online] 2011 [cited 2020 Jun 2];59:257-9. Available from: http://www.ijo.in/text.asp?2011/59/3/257/81028

Dear Editor,

We read with great interest the article by Narayanappa et al. [1] Authors have presented a rare entity of post small incision cataract surgery (SICS) conjunctival inclusion cyst and managed both the cases beautifully without recurrence. But in both the cases, the cyst was ruptured during excision. [1] Acquired conjunctival inclusion cysts occur following traumatic or surgical implantation of conjunctival epithelium. [2],[3] They are thin walled, difficult to excise and rupture is common. Complete excision is recommended for big cysts to prevent recurrences. [4],[5] We would like to share suggestions to excise cysts without rupture. We managed two cases of conjunctival inclusion cyst following SICS without rupture and recurrence.

Both the patients were males, aged 57 and 62 years. They came 6 and 15 months, respectively, after SICS, with complaints of foreign body sensation and small growth in the left eye. Growth was increasing in size. On examination, case 1 had best corrected visual acuity (BCVA) in right eye (RE) 20/40 with nuclear cataract; left eye (LE) was psuedophakic with BCVA 20/30. Conjunctival cyst of 6×8 mm was present on nasal side of limbus at 10 o' clock position [Figure 1]a, b. Case 2 had pseudophakia with BCVA 20/30 in both eyes. Conjunctival cyst of 7 ×6 mm was present at 12 o'clock at limbus in the left eye [Figure 2].
Figure 1: (a) Case 1 left eye conjunctival inclusion cyst nasal side at 10 o'clock position; (b) case 1 close-up of conjunctival inclusion cyst

Click here to view
Figure 2: Case 2 left eye conjunctival inclusion cyst at 12 o' clock position

Click here to view


Both cases were operated under subconjunctival anesthesia by injecting 2 ml of 2% xylocain around the cyst. Incision was given around the cyst with 15 number blade [Figure 3]. Conjunctiva above the cyst was kept intact, which helped to hold the cyst firmly, while blunt dissection was carried out. Care was taken to keep the tip of the corneal scissors away from the cyst. After separating the cyst from all sides [Figure 4], its base was dissected out very carefully as it is the commonest side for rupture. Conjunctiva above the cyst was pulled in the opposite direction of the dissection area, so that fibrous attachments at the base of the cyst were stretched and became easily visible [Figure 5]. They could be cut under direct visualization. It was easy to separate sides and base of the cyst and to remove it without rupture. Conjunctiva was re-positioned at limbus. Excised cysts were examined histopathologically to confirm the diagnosis [Figure 6],[Figure 7]. They were proved to be conjunctival cyst, lined by stratified squamous epithelium and filled with desquamated cells and proteinaceous material inside. Follow-up in case 1 was 18 months [Figure 8] and in case 2 it was 5 months [Figure 9] without recurrence.

To conclude, following four things are suggested for excision of conjunctival inclusion cyst without rupture.

  1. Conjunctiva above the cyst is kept attached to cyst. It provides firm hold to dissect.
  2. Tip of corneal scissors is kept away from cyst.
  3. To dissect base under direct visualization, conjunctiva above the cyst is pulled in opposite direction of dissection area.
  4. It requires patience to excise the delicate cyst.
Figure 3: Incision around the cyst

Click here to view
Figure 4: Cyst separated from all sides, intact conjunctiva is seen on the cyst

Click here to view
Figure 5: Conjunctiva above the cyst pulled in opposite direction to visualize fibrous attachments at base

Click here to view
Figure 6: Histopathology of case 1 conjunctival cyst. (H and E, ×40). Showing cyst lined by stratified squamous epithelium and filled with desquamated cells and proteinaceous material

Click here to view
Figure 7: Histopathology of case 2 conjunctival cyst. (H and E, ×40).Showing cyst lined by stratified squamous epithelium and filled with desquamated cells and proteinaceous material

Click here to view
Figure 8: Case 1 follow-up after 12 months

Click here to view
Figure 9: Case 2 follow-up after 4 months

Click here to view

  Acknowledgments Top


We would like to thank Dr. Kavita Munjaal and Dr. Mallika Kinger, Department of Pathology, for helping in histopathological diagnosis of conjunctival cyst.

 
  References Top

1.
Narayanappa S, Dayananda S, Dakshayini M, Gangasagara SB, Prabhakaran VC. Conjunctival inclusion cysts following small incision cataract surgery. Indian J Ophthalmol 2010;58:423-5.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Song JJ, Finger PT, Kurli M, Wisnicki HJ, Jacob CE. Giant secondary conjunctival inclusion cyst: A late complication of strabismus surgery. Ophthalmology 2006;113:1046-9.   Back to cited text no. 2
    
3.
Williams BJ, Ducan FJ, Mamalis N, Veija J. Conjunctival epithelial inclusion cyst. Arch Ophthalmol 1997;115:816-7.   Back to cited text no. 3
    
4.
Kushner BJ. Suconjunctival cysts as a complication of strabismus surgery. Arch Ophthalmol 1992;110:1243-5.  Back to cited text no. 4
    
5.
Pérez-Flores MI, Ortiz-Rey JA, Antón-Badiola I, Lorenzo-Carrero J. Conjunctival inclusion cyst after strabismus. Arch Soc Esp Oftalmol 2006;81:653-6.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]


This article has been cited by
1 Tenonís Cyst Presenting as a Long-Term Complication following Incision Cataract Surgery
Prabhakar Srinivasapuram Krishnacharya
Case Reports in Medicine. 2013; 2013: 1
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Acknowledgments
References
Article Figures

 Article Access Statistics
    Viewed2445    
    Printed23    
    Emailed0    
    PDF Downloaded156    
    Comments [Add]    
    Cited by others 1    

Recommend this journal