Intrastromal Keratolimbal Epithelial Cysts: Congenital and Postsurgical

Abstract

Two very rare cases of intrastromal keratolimbal epithelial cysts are reported. Firstly, an enlarging congenital cyst in a 9-year-old boy, and secondly, a recurrent postsurgical cyst in an 18-year-old female patient. Both cases presented with a limbal cyst, continuing into the corneal stroma as a whitish mass up to the optical axis. The indication for surgery was stabilization of visual acuity in case one and improvement of cosmetic aspects in case two. In the first case, a small part of the cyst was opened at the limbus and the whitish material in the cyst was flushed out. In the second case, anterior lamellar keratectomy over the whole cyst was performed with subsequent application of mitomycin C. Immunohistochemical analysis revealed cytokeratin 19-positive epithelial cells in both cysts. Therefore, an implantation of conjunctival epithelium into the sclera seems to be responsible for the respective keratolimbal cyst. Postsurgically, satisfying cosmetic and functional results were obtained in both cases, with follow-ups of 4 and 9 months. Keratolimbal cysts have rarely been described in the literature. In most cases, a conjunctival epithelial implantation occurs following surgery or trauma and very rarely congenitally. After simple aspiration of the cystʼs content, a rapid recurrence is often observed, so that partial or – if possible – complete removal of the anterior cyst wall is recommended, as shown in our cases.

Key words

corneal cyst - corneal surgery - epithelial implantation

Publication History

Received: 06 July 2021

Accepted: 27 October 2021

Article published online:
21 February 2022

• Literatur/References

• 1 Jeon S, Choi SH, Wolosin JM. et al. Regeneration of the corneal epithelium with conjunctival epithelial equivalents generated in serum- and feeder-cell–free media. Mol Vis 2013; 19: 2542-2550
• 2 Liakos GM. Intracorneal and sclerocorneal cysts. Br J Ophthalmol 1978; 62: 155-158 DOI: 10.1136/bjo.62.3.155.
• 3 Soni T, Das S. Natural course of congenital corneoscleral cyst: 10-year follow-up. Indian J Ophthalmol 2020; 68: 2217-2218 DOI: 10.4103/ijo.IJO_206_20.
• 4 Mahmood MA, Awad A. Congenital sclerocorneal epithelial cyst. Am J Ophthalmol 1998; 126: 740-741 DOI: 10.1016/S0002-9394(98)00128-7.
• 5 Mifflin M, Byers T, Elliot R. et al. Surgical Treatment of an Intrastromal Epithelial Corneal Cyst. Cornea 2001; 20: 222-225
• 6 Wilhelmus KR, Font RL, Thorn GC. [Corneal cyst]. J Fr Ophtalmol 1992; 15: 363-365
• 7 Bloomfield SE, Jakobiec FA, Iwamoto T. 5. Traumatic Intrastromal Corneal Cyst. Ophthalmology 1980; 87: 951-955 DOI: 10.1016/S0161-6420(80)35141-5.
• 8 Al-Towerki AE, Binali G. Traumatic epithelial inclusion cyst of the anterior corneal stroma. Cornea 2008; 27: 368-369 DOI: 10.1097/ICO.0b013e31815d18ce.
• 9 Fox A, Pineda R, Liu S. Spontaneously Regressed Corneal Intrastromal Cyst. Ophthalmology 2020; 127: 1383 DOI: 10.1016/j.ophtha.2020.06.011.
• 10 Gokhale NS. Management of recurrent intra corneal epithelial cyst with ethanol irrigation and vacuum-assisted cyst wall excision. Int Ophthalmol 2013; 33: 429-433 DOI: 10.1007/s10792-012-9677-3.
• 11 Shin YJ, Wee WR, Kim M. et al. Corneoscleral cyst treated with distilled water injection. Korean J Ophthalmol 2002; 16: 110-113 DOI: 10.3341/kjo.2002.16.2.110.
• 12 Reed JW, Dohlman CH. Corneal Cysts: A Report of Eight Cases. Arch Ophthalmol 1971; 86: 648-652 DOI: 10.1001/archopht.1971.01000010650007.
• 13 Zare MA, Mehrjardi HZ, Golabdar MR. Management of an intrastromal corneal epithelial cyst, from simple drainage to keratoplasty. Oman J Ophthalmol 2012; 5: 196 DOI: 10.4103/0974-620X.106107.