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ARTICLES
Year : 1983  |  Volume : 31  |  Issue : 7  |  Page : 884-885

Implantation cyst in A.C. after cataract surgery


Central Hospital, Dhanbad, Bihar, India

Correspondence Address:
Lakshmi Narain
Senior Eye Specialist, Central Hospital, Dhanbad, Bihar
India
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Source of Support: None, Conflict of Interest: None


PMID: 6544277

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How to cite this article:
Narain L, Sinha A K. Implantation cyst in A.C. after cataract surgery. Indian J Ophthalmol 1983;31, Suppl S1:884-5

How to cite this URL:
Narain L, Sinha A K. Implantation cyst in A.C. after cataract surgery. Indian J Ophthalmol [serial online] 1983 [cited 2020 Oct 1];31, Suppl S1:884-5. Available from: http://www.ijo.in/text.asp?1983/31/7/884/29693

One of the rare and intractable complica­tions of cataract surgery and perforating in­juries of the eye is "Implantation Cyst in ante­riar chamber". The usual reason being faulty wound closure, improper toileting and forma­tion of. retrocorneal membrance due to en­dothelial metaplasia. This leads to epithelial ingrowth in A.C. over the iris surface and corneal endothelium. The cyst is usually un­ilocular but some times multilocular. Occasi­onally in perforating injury the conjunctival and corneal epithelium possibly get implanted over the iris surface leading to cyst formation. With use of magnification and operating mic­roscope incidence of this complication is be­coming less.


  Material and methods Top


Three patients who were operated for cataract with uneventful recovery reported be­tween six months to two years postopera­tively. Two patients were operated out side with knife incision and third one was done at Central Hospital, with corneal stitching. In all the three patients the I.O.P. was elevated with accompanying symptoms of pain, lacrimation and photophobia.

Case No. 1:

G.N. (45 M) four months after his cataract operation in left Eye, felt pain, lacrimation and dimness of vision. On slitlamp examina­tion the cornea was hazy with epithelialisation of posterior corneal surface and small cystic growth in A. C. over the superolateral part of Iris. Anterior chamber was deep except in the involved portion. Fundus examintion showed normal disc. The I.O.P. was 29 mm of Hg/ Schiotz's. The corrected vision was 6/24 (?)

Case No. 2:

M.K.G. (47 M) was opoerated for ctaract Right eye. One year later he developed pain and dimness of vision. On examination the cornea was hazy in upper and outer part with epithelialisation of posterior corneal surface and cyst over superior part of Iris.The I.O.P. was high and the vision came down to hand movement.

Case No. 3:

M.M. (56 M) reported with complaints of dimness of vision in Right eye. History of cataract operation one year back. On exami­nation corrected vision R.E. was 6/60. There was a cystic growth on superomidial aspect of A.C. involving the iris and corneal en­dothelium.

All the three cases did not repond to medi­cal therapy of miotics and oral carbonic anhyd­rase inhibitors. Thus surgery for excision of the cyst was planned. An abexterno scleral in­cision of the sector of anterior chamber in­volved was made. Anterior chamber was adequately exposed with liberal incision and Cyst excised, sector iridectomy with one mm healthy iris done. Endothelial surface of the cornea was curreted using a very fine chalaz­ion scoop. Cryo application using the cataract pencil was done over the exposed iris root, margins of the iris coloboma and ciliary body. Scleral wound was closed. Anterior formed with sterile air. Subconjuctival Gentamycin and decadron injection given.

Patients were kept on antibiotics for five days. Eye was dressed daily. Postoperative complication of . Hyphaema occured in one case which cleared off subsequently. Conjucti­val stitches were removed on fifth post opera­tive day. During a twelve week follow up pa­tients were relieved of the symptoms and I.O.P. was controlled. Visual improvement was found only in one case and another eye the tension bnecame very low.


  Discussion Top


Epithelial ingrowth and fibrous prolifera­tion in anterior chamber has been reported post-operatively and after injury to the eye. The incidence of such complications has gradually deminished due to improvement in surgical skill, operating microscope and proper wound closure. Despite this cases of epithelial cyst in anterior chamber do occur and have been reported by different authors. Medical treatment has no place in the treat­ment of the above conditioin. Surgical treat­ment by different procedures have shown var­iable results. Recent advancements have in­cluded the use of cryocoagulation and photo­coagulation in the treatment of epithelial inva­sion. Different nomenclatures like Epithalial­cyst, Epithelial ingrowth and fibrous prolifera­tion or metaplasia have been given. The causa­tion of the above condition has been post­ulated assigning instrumentation, collulose sponge, cotton fibres, left in the eye during surgery and due to suture tract. It has been proved that conjunctival flaps are not a cause for such growth in anterior chamber. Histolog­ical examination of the tissue under Electron microscope has added more knowledge about its structure. The causes for glaucoma have been postulated (1) Epithelium lining the trabecular meshwork (2) Dense anterior synechiae closing the angle (3) a papillary block mechanism and/or blockage of the angle by "Desquamating epithelial cells in the form of particulate matter."

Differencial diagnosis includes Neuro­epithelial cyst, pigmant epithelial cyst of the iris, parasitic cyst and congenital iris cyst. In the management of the epitheliat cyst number of treatment have been tried using X-Ray therapy. Chemical cautery, Electrolysis and diathermy. Presently Cryotherapy, photo­coagulation, excision of the iris, chemical cautery are being used.

The Excision of the cyst, sector iridectomy, curretting of the endothelial surface of cornea and cryo application were done in this series. Results have not been very satisfactory in as much as one eye become phithisical due to low tension, other eye could only be salvaged and the third eye had only marginal visual im­provement.


  Summary Top


Three cases of implanation cyst in anterior chamber after intracapsular cataract opera­tions have been surgically treated. In all the cases presenting symptoms were pain, lacri­mation, redness and dimness of vision. In­traocular pressure was elevated ranging bet­ween 28 to 40 mm/Hg Schiotz's. Surgical exci­sion of the cyst by abextern scleral incision was done. There were symptomatic relief in all cases and maginal visual improvement in only one case.




 

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