Year : 1983 | Volume
: 31 | Issue : 7 | Page : 884--885
Implantation cyst in A.C. after cataract surgery
Lakshmi Narain, AK Sinha
Central Hospital, Dhanbad, Bihar, India
Senior Eye Specialist, Central Hospital, Dhanbad, Bihar
|How to cite this article:|
Narain L, Sinha A K. Implantation cyst in A.C. after cataract surgery.Indian J Ophthalmol 1983;31:884-885
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Narain L, Sinha A K. Implantation cyst in A.C. after cataract surgery. Indian J Ophthalmol [serial online] 1983 [cited 2021 Sep 17 ];31:884-885
Available from: https://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
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.
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.
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.