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| PHOTO ESSAY |
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| Year : 2021 | Volume
: 1
| Issue : 1 | Page : 39-40 |
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Intrastromal corneal epithelial cyst – When to intervene
Raj S Paul1, Meena Lakshmipathy1, Akila Ramkumar2, J Karthick3
1 Department of Cornea and Refractive Surgery, Medical Research Foundation, Sankara Nethralaya, 18 College Road, Chennai, Tamil Nadu, India
2 Department of Pediatric Ophthalmology and Strabismus, Medical Research Foundation, Sankara Nethralaya, 18 College Road, Chennai, Tamil Nadu, India
3 Department of Optometry, Medical Research Foundation, Sankara Nethralaya, 18 College Road, Chennai, Tamil Nadu, India
| Date of Submission | 19-May-2020 |
| Date of Acceptance | 19-Jul-2020 |
| Date of Web Publication | 31-Dec-2020 |
Correspondence Address:
Dr. Meena Lakshmipathy
Sankara Nethralaya, 18 College Road, Nungambakkam, Chennai - 600 006, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijo.IJO_1568_20
Keywords: Anterior segment optical coherence tomography, intracorneal cyst, post squint surgery
How to cite this article:
Paul RS, Lakshmipathy M, Ramkumar A, Karthick J. Intrastromal corneal epithelial cyst – When to intervene. Indian J Ophthalmol Case Rep 2021;1:39-40 |
How to cite this URL:
Paul RS, Lakshmipathy M, Ramkumar A, Karthick J. Intrastromal corneal epithelial cyst – When to intervene. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Mar 3];1:39-40. Available from: https://www.ijoreports.in/text.asp?2021/1/1/39/305491 |
A 12-year-old female presented with a right eye white opacity noticed by her parents 2 years ago [Figure 1]. There was no history of childhood corneal trauma. The child was diagnosed to have V pattern exotropia for which she underwent inferior oblique recession of both eyes 9 years ago. Post-surgery she was prescribed glasses and her refraction remained unchanged in the last 2 years. On examination, the best-corrected visual acuity (BCVA) in the right eye was 20/20 (−2.25 Dsph/−0.75 Dcyl X 40°) and in the left eye was 20/20 (−3.25 Dsph). Slit-lamp biomicroscopy of the right eye revealed a 4 mm mid-stromal leucomatous triangular-shaped lesion with the apex towards 7 o'clock limbus [Figure 2]. Four mirror gonioscopy showed no communication into the anterior chamber. Anterior segment optical coherence tomography (ASOCT) (Cirrus HD-OCT 5000, Carl Zeiss Meditec Inc. Dublin, CA, USA) demonstrated hyper-reflective homogenous echoes casing shadow at mid-stromal level with extension beyond limbus and measuring 4.92 mm vertically, 3.53 mm horizontally at 2.18 mm depth from the epithelial surface [Figure 3]. Given unvarying nature over 6 months follow-up, no visual obscuration, acceptable cosmesis, and parents' reluctance on any surgical measures; the decision was taken in favor of conservative management. | Figure 1: Digital photograph of the anterior segment of the right eye showing corneal cyst under diffuse illumination
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 | Figure 2: Digital photograph of the anterior segment of the right eye showing corneal cyst in the slit section
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 | Figure 3: High resolution cross-sectional corneal image (ASOCT) of the right eye showing corneal cyst: (a) intra-stromal location (green arrow) (b) flap tool to measure the depth and extent (c) beyond limbal cyst communication into the sclera (red arrow)
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| Discussion | |  |
Corneal cysts were first described by Appia in 1853.[1] Sequestration of epithelial cells in corneal stroma either developmentally or following trauma with their subsequent proliferation accounts for the cyst growth.[2] Cysts have been reported to develop following cataract surgery, lamellar keratoplasty, and squint surgery.[3] Intrastromal cysts can be treated using distilled water, 5-fluorouracil, or 20% trichloroacetic acid. In advanced cases, lamellar or penetrating keratoplasty may be needed.[4] Corneal cysts not affecting vision can be managed conservatively and surgical intervention should be taken only in progressive cases.[3] Furthermore, this case emphasizes that surgical trauma even after many years can give rise to corneal cysts. Besides, ASOCT is a noninvasive tool to determine cysts' depth, limbal communication, and documenting progression to aid in planning future surgical intervention.[5]
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Reed JW, Dohlman CH. Corneal cysts. Arch Ophthalmol 1971;86:648-52.  |
| 2. | Rao SK, Fogla R, Biswas J, Padmanabhan P. Corneoscleral epithelial cysts: Evidence of developmental etiology. Cornea 1998;17:446-50. |
| 3. | Bhatt P, Ramaesh K. Intrastromal corneal limbal epithelial implantation cyst. Eye 2007;21:133-5. |
| 4. | Zare MA, Mehrjardi HZ, Golabdar MR. Management of an intrastromal corneal epithelial cyst, from simple drainage to keratoplasty. Oman J Ophthalmol 2012;5:196-7. [ PUBMED] [Full text] |
| 5. | Mazumdar D, Lal B, Asokan R. Anterior segment optical coherence tomography of intrastromal corneal cysts. Asian J Ophthalmol 2020;17:41-4. |
[Figure 1], [Figure 2], [Figure 3]
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