[Block excision with tectonic corneoscleroplasty for cystic and/or diffuse epithelial invasion of the anterior eye segment. Report of 51 consecutive patients (1980-1996)].
OBJECTIVE
Many surgical and nonsurgical techniques for the treatment of cystic and/or diffuse sheet-like epithelial ingrowth of the anterior chamber led to recurrences or even enucleation of the eye.


METHODS
There were 32 (62.7%) men and 19 (37.3%) women ranging in age from 1 month to 80 years (median, 55.5 years). Cystic epithelial ingrowth occurred in 45 patients, and diffuse sheet-like epithelial downgrowth in 6 patients. Block excision consisted of simultaneous en bloc removal of epithelial ingrowth together with adjacent iris, pars plicata of the ciliary body, and cornea and sclera in full-thickness. The resulting defect was covered with a tectonic corneoscleral graft. The median follow-up was 7.9 years.


RESULTS
The main causes for epithelial ingrowth were trauma (41.2%) and complicated cataract extractions (27.5%). Eleven patients had undergone surgery of epithelial ingrowth before block excision, elsewhere. Epithelial ingrowth involved up to 5 clock hours of the circumference of the chamber angle (median, 3 clock hours). The median preoperative visual acuity was 0.3 (range, hand motions -1.0). The median diameter of the block excision was 8.0 mm (range, 5.5-12.0 mm). The main postoperative complications were vitreous hemorrhage (27.5%) and corneal endothelial decompensation (21.6%). The median postoperative visual acuity was 0.2. Visual acuity was > or = 0.3 in 43.1% of patients and < 0.1 in 35.3% of patients. Visual results were significantly better after simultaneous cataract extraction with intraocular lens implantation (n = 5). Histopathologically, the invading epithelium mainly consisted of nonkeratinizing squamous epithelium with goblet cells (64.7%). There was a secondary proliferation of corneal endothelium on the cyst's surface in 82.4% of patients. There was no clinical evidence of recurrence of epithelial ingrowth, and no enucleation had to be performed during follow-up.


CONCLUSIONS
Block excision with tectonic corneoscleral grafting is the treatment of choice for cystic and/or diffuse sheet-like epithelial ingrowth of the anterior chamber or anterior uvea, retrospectively.
Rummelt
V
V
Augenklinik mit Poliklinik, Universität Erlangen-Nürnberg.
Naumann
G O
GO
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000867:Anterior Chamber / Q000473:pathology / Q000601:surgery*; D002387:Cataract Extraction; D002648:Child; D002675:Child, Preschool; D016039:Corneal Transplantation / Q000379:methods*; D003560:Cysts / Q000473:pathology / Q000601:surgery*; D004728:Endothelium, Corneal / Q000473:pathology / Q000601:surgery; D019573:Epithelium, Corneal / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D016639:Scleroplasty / Q000379:methods*
Blockexzision mit tektonischer Korneoskleralplastik wegen zystischer und/oder diffuser Epithelinvasion des vorderen Augenabschnitts. Bericht über 51 konsekutive Patienten (1980-1996).