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We present the use of anterior segment optical coherence tomography (OCT) in monitoring intraocular epithelial cysts in children. Both patients had traumatic corneal laceration and subsequently developed epithelial downgrowth cysts.
Case 1
A 6-year-old boy presented 2 days after being struck with a wooden brick. On presentation, there was a full-thickness corneal laceration and two clock hours of the iris prolapsed through the limbal wound. He underwent primary repair of the wound and iris excision and was followed up 4 weeks later by removal of sutures, lens extraction and anterior vitrectomy.
Six months later, his vision had decreased, and he was found to have developed a large intraocular cyst. This was treated by aspiration and injection of intralesional mitomycin C (MMC) (0.3 ml of 0.001 mg/ml). The cyst involuted and vision improved. Sequential OCT measurements for 2 years have shown the cyst to remain stable at 5.58×2.19 mm (maximal diameter) with no invasion of the angle (see figure 1).
Large intraocular cyst 2 years after injury.
Case 2
A 3-year-old boy presented after a collision with a wooden cabinet. On examination under anaesthesia, he was found to have four clock hours of corneoscleral laceration with iris prolapse. The wound was repaired. Six months later, he developed a clear cystic lesion anterior to the iris, adjacent to the original wound. The cyst was excised and treated with antimetabolites on three occasions for 4 years. After this, the cyst was monitored using Visante OCT, which demonstrated stability for 2 years. However, 6 years after injury, the eye became inflamed with raised intraocular pressure. OCT demonstrated recurrence of the cyst with associated angle invasion (see figure 2).
Angle invasion with recurrence of cyst 6 years after injury.
Conclusion
OCT is a non-contact and well-tolerated imaging modality with high resolution.1 2 To our knowledge, the use of anterior segment OCT in imaging intraocular cysts has not previously been reported. We feel that this method of observation confers certain advantages over other modalities, particularly children, with a non-invasive, fast (25 milliseconds) acquisition time, calliper tool and image manipulation. It can be of particular benefit in eyes with an opaque cornea. We have demonstrated its benefit in surgical planning and determining aetiology of secondary pressure rise.
Footnotes
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; not externally peer reviewed.