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Year : 2022  |  Volume : 2  |  Issue : 1  |  Page : 251-252

Surgical approach of congenital sclerocorneal cyst: A case report and literature review


1 Department of Ophthalmology, Hospital Sungai Buloh; Department of Ophthalmology, UM Eye Research Centre, University of Malaysia, Kuala Lumpur, Malaysia
2 Department of Ophthalmology, UM Eye Research Centre, University of Malaysia, Kuala Lumpur, Malaysia
3 Department of Ophthalmology, Hospital Sungai Buloh, Kuala Lumpur, Malaysia

Date of Submission31-May-2021
Date of Acceptance30-Jun-2021
Date of Web Publication07-Jan-2022

Correspondence Address:
Dr. Sujaya Singh
Department of Ophthalmology, UM Eye Research Centre, University of Malaysia, Kuala Lumpur
Malaysia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1513_21

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  Abstract 


Keywords: Sclerocorneal cyst, 5-Fluorouracil, excision of scleral cyst, scleral patch graft, case report


How to cite this article:
Ng PY, Singh S, Chan UT, Ismail F, Retnasabapathy S. Surgical approach of congenital sclerocorneal cyst: A case report and literature review. Indian J Ophthalmol Case Rep 2022;2:251-2

How to cite this URL:
Ng PY, Singh S, Chan UT, Ismail F, Retnasabapathy S. Surgical approach of congenital sclerocorneal cyst: A case report and literature review. Indian J Ophthalmol Case Rep [serial online] 2022 [cited 2022 Jan 16];2:251-2. Available from: https://www.ijoreports.in/text.asp?2022/2/1/251/334884



An 8-year-old boy was referred for sight-threatening right eye (RE) sclerocorneal cyst. On presentation, BCVA was + 6.00/−6.00 × 140 (6/12). Right sclerocorneal cyst was seen nasally [Figure 1]. B-scan ultrasonography showed an intrascleral cyst without extension into the vitreous cavity and anterior segment optical coherence tomography (AS-OCT) revealed an extension of the scleral cyst into the corneal stroma [Figure 2]. The patient underwent irrigation of the cyst with 5-Fluorouracil (5-FU) 5% and sterile water. Post irrigation the scleral cyst wall was excised, and residual thin sclera was covered with a scleral patch graft. Postoperatively, the patient received topical prednisolone 1% and chloramphenicol 0.5% 2 hourly, which was tapered accordingly. The cyst resolved completely by the third month postoperatively [Figure 3]. Right eye refraction improved to +1.50/-1.50x140 (6/9) and there has been no recurrence of the cyst in the 2-year follow-up period post-surgery [Figure 4].
Figure 1: RE sclerocorneal cyst nasally (white arrow), measured 6.2 mm (horizontally) from the limbus encroaching into the visual axis, the scleral part of the cyst measured 5 mm (horizontally) from the limbus and the area of limbus involved measures 4 mm vertically

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Figure 2: Right eye AS-OCT: Extension of scleral cyst into cornea stroma (white asterisk)

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Figure 3: Postoperative review at 3 months: Resolved corneoscleral cyst with well apposed corneal lamellae

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Figure 4: Complete resolution of sclerocorneal cyst

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  Discussion Top


Conservative management is usually preferred for nonvision threatening sclerocorneal cyst due to its high recurrence rate,[1] while surgical intervention is reserved for sight-threatening sclerocorneal cysts.[2] However, there is no consensus on the best surgical approach for the management of a sclerocorneal cyst. Complete eradication of entrapped epithelial cells within the cyst is the key factor for the prevention of recurrence.[3]

Chemical solutions such as 96% ethanol,[4] 10% trichloroacetic acid,[1] and distilled water[5] have been used for irrigation of the cyst to eradicate the epithelial cells. Kalamkar and Mukherjee[3] did deroofing of scleral cyst with a thorough scraping of epithelial cells over the base and sidewalls of the scleral cyst.

In view of the large sclerocorneal cyst in our patient, we chose to irrigate the cyst with sterile water and 5-FU followed by scleral deroofing and scleral patch. Maintenance of a closed system during irrigation is important to prevent leaking of the chemicals into the anterior chamber, which can lead to damage of the corneal endothelium.

Declaration of patient consent

The authors certify that they have obtained all appropriate consent, which includes permission for images and other clinical information to be reported in the journal. The patient's parents understand that their son name and initials will not be published, and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kim SW, Kim EK. Portable OCT-assisted surgical treatment of intracorneal pre-Descemet epithelial cyst: A case report. BMC Ophthalmol 2017;17:160.  Back to cited text no. 1
    
2.
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.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Kalamkar C, Mukherjee A. Primary corneoscleral cyst in a pediatric patient. Case Rep Ophthalmol 2017;8:425-8.  Back to cited text no. 3
    
4.
Ali Javadi M, Sharifi A, Hashemian SJ, Yazdani S, Parvizi G, Kanavi MR. Management of intracorneal epithelial cysts with ethanol irrigation and cyst wall excision: A clinicopathologic report. Cornea 2006;25:479-81.  Back to cited text no. 4
    
5.
Shin YJ, Wee WR, Kim M, Lee JH. Corneoscleral cyst treated with distilled water injection. Korean J Ophthalmol 2002;16:110-13.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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