Surgical management of anterior chamber epithelial cysts.
OBJECTIVE
To review management strategies for treatment of anterior chamber epithelial cysts.


METHODS
Retrospective review of consecutive interventional case series.


METHODS
Charts of patients treated for epithelial ingrowth over a 10-year period by a single surgeon were reviewed. Cases of anterior chamber epithelial cysts were identified and recorded, including details of ocular history, preoperative and postoperative acuity, intraocular pressure (IOP), and ocular examination, type of surgical intervention, and details of further procedures performed.


RESULTS
Seven eyes with epithelial cysts were identified. Patient age ranged from 1.5 to 53 years at presentation. Four patients were children. In four eyes, cysts were secondary to trauma, one case was presumably congenital, one case developed after corneal perforation in an eye with Terrien's marginal degeneration, and one case developed after penetrating keratoplasty (PK). Three eyes were treated with vitrectomy, en bloc resection of the cyst and associated tissue, fluid-air exchange and cryotherapy. The last four eyes were treated with a new conservative strategy of cyst aspiration (three cases) or local excision (one keratin "pearl" cyst), and endolaser photocoagulation of the collapsed cyst wall/base. All epithelial tissue was successfully eradicated by clinical criteria; one case required repeat excision (follow-up, 9 to 78 months, mean 45). Two eyes required later surgery for elevated IOP, two for cataract extraction and one for repeat PK. Final visual acuity ranged from 20/20 to hand motions, depending on associated ocular damage. Best-corrected visual results were obtained in the more conservatively managed eyes.


CONCLUSIONS
Anterior chamber epithelial cysts can be managed conservatively in selected cases with good results. This strategy may be particularly useful in children's eyes, where preservation of the lens, iris, and other structures may facilitate amblyopia management.
Haller
Julia A
JA
Wilmer Ophthalmological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. jhaller@jhmi.edu
Stark
Walter J
WJ
Azab
Amr
A
Thomsen
Robert W
RW
Gottsch
John D
JD
D000328:Adult; D000867:Anterior Chamber / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003316:Corneal Diseases / Q000473:pathology / Q000601:surgery*; D003452:Cryosurgery; D003560:Cysts / Q000473:pathology / Q000601:surgery*; D004847:Epithelial Cells / Q000473:pathology*; D019573:Epithelium, Corneal / Q000473:pathology; D005260:Female; D006801:Humans; D007223:Infant; D007429:Intraocular Pressure; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014792:Visual Acuity; D014821:Vitrectomy