Surgical approaches to the management of epithelial cysts

The purpose of this study was to review management strategies for treatment of epithelial cysts.

Retrospective consecutive interventional case series.

Charts of patients treated for epithelial ingrowth over a 10-year period by a single surgeon (J.A.H.) were reviewed. Cases of epithelial cysts were identified and the following data were recorded: details of ocular history, preoperative and postoperative visual acuity, intraocular pressure (IOP), ocular examination findings, type of surgical intervention, and details of subsequent procedures performed.

Seven eyes with epithelial cysts were identified. Patients ranged in age from 1 1/2 years to 53 years at presentation. Three patients were children. Four cysts were due to trauma, one was presumably congenital, one developed after corneal perforation in an eye with Terrien's marginal degeneration, and one developed after penetrating keratoplasty. Three patients were treated with vitrectomy, en bloc resection of the cyst and associated tissue, fluid-air exchange, and cryotherapy. Four patients were treated with conservative strategy consisting of cyst aspiration (three cases) or local excision (one "keratin pearl" cyst) and endolaser photocoagulation of the collapsed cyst wall or base. In all cases, the epithelial tissue was successfully eradicated; one case required a second excision (follow-up, 9 months to 78 months; mean, 45 months). Two eyes required subsequent surgery for elevated IOP, two for cataract extraction, and one for a second penetrating keratoplasty. Final visual acuity ranged from 20/20 to hand motions, depending on associated ocular damage. Best visual results were obtained in the more conservatively managed eyes.

Epithelial cysts can be managed conservatively in selected patients with good results. This strategy may be particularly useful in children, in whom preservation of the lens, iris, and other structures may facilitate amblyopia management.