Orbital conjunctival dermoid cyst with oncocytic differentiation

A dermoid cyst of conjunctival origin ("conjunctivoid") is a rare variant that has conjunctival nonkeratinizing squamous epithelium and goblet cells, instead of keratinizing squamous epithelium of epidermal origin with epidermal appendages. We report a case of a 65-year-old man with a chronic orbital mass, a conjunctival dermoid that was found to have the unusual histopathologic finding of oncocytic differentiation. This is an infrequent benign chronic change in glandular cells characterized by the accumulation of vast numbers of intracellular mitochondria. Occasionally, oncocytic cellular change occurs in malignant tumors, and so complete excision of such lesions is recommended.     

下直肌后退联合下睑筋膜头分离复位在甲状腺相关眼病患者斜视矫正术的应用

目的探讨甲状腺相关眼病患者下直肌后退术中下睑退缩的防治措施。方法 回顾性病例研究。广州中山大学中山眼科中心2007年1月至2011年12月行下直肌后退术的甲状腺相关眼病患者24例,其中男18例,女6例;平均年龄（47.8±10.7）岁。甲状腺相关眼病患者下直肌后退术中除充分分离下直肌与下睑的联系外,同时将与下直肌相联的下睑筋膜头分离并标记,下直肌后退后将下睑筋膜头缝回到下直肌原肌止点处。结果 下直肌后退量2.5～8.0 mm,平均为（5.31±1.16）mm,仅5例在术后出现轻度的下睑退缩,术后下睑位置总量改变为0。2例患者显示下方巩膜暴露,但睑裂大小无改变。所有患者术后无下睑其他外观改变。结论 下直肌后退术中充分分离下睑与下直肌的联系,同时分离下睑筋膜头并缝回到下直肌原肌止点处可有效防治甲状腺相关眼病患者下直肌后退术后的下睑退缩。     

Acquired ptosis associated with a conjunctival cyst

A 44-year-old woman with a history of previous ptosis surgery presented with a moderate ptosis of the left upper eyelid and a large cystic mass extending over the length of that lid. The mass was excised completely and histologically found to be a conjunctival ductal cyst. The levator aponeurosis was disrupted by the cyst and required reconstruction. This case demonstrates an acquired ptosis associated with a large conjunctival cyst as a late complication of ptosis surgery.     

A modified technique for conjunctival transplant.

An improved technique for the harvesting and placement of conjunctival autograft in complex, advanced and recurrent pterygia is presented. A paper template, fashioned to the approximate size of the pterygium excision site, is used to mark and subsequently transfer the conjunctival graft to the recipient bed. The template creates a strong, steady scaffold on which to orient and align the floppy conjunctival graft. This permits easier suturing and more accurate placement of the graft. We report a series of 30 eyes in which all transplants were taken from the superior or superotemporal bulbar conjunctiva of the same eye. There were no intraoperative or postoperative complications. No graft failures or graft retractions were seen. Although there have been several cases of partial recurrence, we have not had to resort to repeat surgery. We present this modification of a technique originally developed by Thoft and later refined by Vastine and Kenyon, as an effective way to correct complex, advanced, and recurrent pterygia.     

Fornix reconstruction with conjunctival inclusion cyst marsupialization in Stevens-Johnson syndrome

A 17-year-old boy presented with multiple, progressively enlarging cystic masses located at the junction of the lower eyelids and anterior orbit, 1 year after recovery from Stevens-Johnson syndrome. Bilaterally, symblepharon obliterated the inferior fornix and restricted supraduction. All but 1 cyst (which was sent for microscopic evaluation) was marsupialized. Cut edges of the cysts were sutured to adjacent conjunctiva and the epithelial walls were used as fornix lining. Histologically, the wall of the excised cyst consisted of conjunctiva. One year after surgery, the inferior fornices remained substantially deepened with improved ocular motility. This case demonstrated that conjunctival inclusion cysts occurring in the aftermath of Stevens-Johnson syndrome can be effectively managed with marsupialization. The epithelial lining can then be used in fornix reconstruction.     

The contribution of inflammatory cell infiltration to conjunctival inclusion cyst formation

PURPOSE: The incidence of inclusion cysts was examined histopathologically in conjunctival disorders where inflammatory cell infiltration was seen in the subepithelial connective tissue. METHOD: The incidence of inclusion cysts was examined histopathologically in pterygium, vernal conjunctivitis, pyogenic granuloma and pingueculitis. The specimens of pinguecula were used as control. RESULTS: Inclusion cysts were recognized in 5/55 cases of pterygium, 2/12 cases of vernal conjunctivitis, 1/4 cases of pyogenic granuloma, and 1/2 cases of pingueculitis. On the other hand no inclusion cyst was recognized in 20 cases of pinguecula in which no inflammatory cell infiltration was seen. CONCLUSIONS: Inflammatory cell infiltration may contribute to the formation of conjunctival inclusion cysts in pterygium, pingueculitis, vernal conjunctivitis and pyogenic granuloma.     

Suprachoroidal seton implantation in refractory glaucoma: a novel surgical technique

PURPOSE: To describe a new surgical technique in which aqueous humor is diverted from the anterior chamber to the suprachoroidal space for the augmentation of uveoscleral outflow in the management of refractory glaucoma. METHODS: Four painful-blind eyes of four consecutive patients were included in the study. Mean age of patients was 54.7+/- 9.2 years. Preoperative diagnosis was neovascular glaucoma complicating diabetic retinopathy in three cases and chronic angle-closure glaucoma in one case. Mean preoperative intraocular pressure of the patients receiving two medications was 58.5 +/- 9.2 mm Hg. A modified Krupin eye valve with disk was implanted into the suprachoroidal space. The anterior tube part of the Seton device was placed into the anterior chamber through the long scleral tunnel for draining the aqueous humor from the anterior chamber to the suprachoroidal space. RESULTS: The placement of modified Krupin eye valve with disk to the suprachoroidal space was achieved in all cases. While mean preoperative intraocular pressure was 58.5 +/- 9.2 mm Hg, it was 14.2 +/- 4.7 mm Hg at postoperative one week. It was 13.5 +/- 4.6 mm Hg and 15 +/- 4.9 mm Hg at one and three months respectively. At the last follow-up visit, mean intraocular pressure was 17.25 +/- 5.37 mm Hg ranging from 12 to 24 mm Hg. Choroidal detachment was developed in one case and regressed in six weeks. Rubeosis irides regressed at third month in three cases. None of the eyes developed suprachoroidal hemorrhage, retinal detachment, or phthisis bulbi. CONCLUSION: The drainage of aqueous humor from the anterior chamber to the suprachoroidal space with the implantation of the glaucoma Seton device is effective in lowering intraocular pressure in refractory glaucoma.     

Transconjunctival flap sutures: A novel technique to combat hypotony

Background:Hypotony secondary to overfiltration is a recognized complication following trabeculectomy. Persistent hypotony requires intervention .Purpose:We describe a modified version of placing conjunctival compression sutures directly over the scleral flap.Synopsis:A 70-year-old male patient diagnosed with primary open angle glaucoma in both eyes underwent combined surgery in the right eye. On the tenth post-operative day, the patient presented with severe hypotony with 360° choroidal detachment. He was treated with corticosteroids and cycloplegics but developed hypotony maculopathy on the subsequent follow-up. Hence, he was further managed surgically by trans-conjunctival flap sutures to which he responded favorably with resolution of choroidal detachment and improvement in intraocular pressure and visual acuity.Highlights:Transconjunctival suturing of the scleral flap is an effective and minimally invasive treatment to prevent visual loss from hypotony maculopathy for an overfiltering bleb following trabeculectomy.Online Video Link: https://youtu.be/BJtUZcyQZ-w     

Pterygium excision with conjunctival autografting: an effective and safe technique.

The optimum mode of treatment for symptomatic pterygia would combine efficacy (a low recurrence rate) with safety (freedom from sight threatening complications), and would not affect visual acuity adversely. The efficacy of pterygium excision with conjunctival autografting in a sun exposed population in which pterygia are prevalent has previously been questioned. A cross sectional review of 93 eyes of 85 patients was carried out by slit-lamp examination a minimum of 6 months (range 6-76 months) after pterygium excision and free conjunctival autografting. Case notes were reviewed to obtain details of complications and visual acuity changes related to surgery. Of six recurrences (6.5%) four of these were asymptomatic with minor recurrences. Two patterns of recurrence were identified: cross graft recurrence (three cases) and outflanking (three cases). Complications (wound dehiscence, three cases; Tenon's granuloma one case; conjunctival cyst, one case) were all corrected by minor surgical revision without sequelae. Unaided acuities were unchanged or improved 3 months after surgery in 86 cases, with a minor diminution (1 Snellen line) in seven cases. This study demonstrates a low recurrence rate for a safe technique in an area in which ongoing ultraviolet light exposure levels are high and pterygia are prevalent.     

Report of an unusual case of a conjunctival cyst with Liesegang rings

Liesegang rings are laminated precipitation structures well recognized in the field of chemistry. We present a rare case of a 64-year-old man who sought examination for a conjunctival cystic lesion of several months' duration, located in the right nasal bulbar conjunctiva near the plica semilunaris. The lesion was excised completely and uneventfully under local anaesthesia. Histopathological examination revealed a large folded cyst in the substantia propria. The cyst contained multiple eosinophilic concentrically spherical and oval structures of variable size with an amorphous central core compatible with Liesegang rings. No fungal or parasitic organisms were identified. This is the first photographically documented case of Liesegang rings appearing in the conjunctiva. Liesegang ring formation should be taken into account during histopathological examination of a conjunctival cyst and not be misdiagnosed as a parasitic infection.