Treatment of conjunctival cysts in anophthalmic socket with intralesional injection of trichloroacetic acid (ATA) 25%

Abstracts

Cistos conjuntivais em cavidades anoftálmicas podem ter implicações funcionais e estéticas negativas para os pacientes. Dentre as opções terapêuticas disponíveis, o uso do ácido tricloroacético é relativamente recente. Os casos relatados apresentaram boa evolução após 30 dias do tratamento, sendo bem tolerado pelos pacientes e possibilitando maior preservação de tecido conjuntival.

Doenças da túnica conjuntiva; Órbita; Ácido tricloroacético; Ácido tricloroacético; Prótese ocular; Relatos de casos

CASE REPORT

Treatment of conjunctival cysts in anophthalmic socket with intralesional injection of trichloroacetic acid (ATA) 25%

Fabricio Lopes da Fonseca^I; Renata de Iracema Pulcheri Ramos^II; Suzana Matayoshi^III

^IOphthalmologist, Fellow at the Oculoplastic Surgery Unit, Department of Clinical Ophthalmology, University Hospital of the São Paulo University (USP), São Paulo/SP, Brazil

^IIOphthalmologist and Supervisor at the Department of Clinical Ophthalmology, University Hospital of the São Paulo University (USP), São Paulo/ SP, Brazil

^IIIAssociate Professor and Head of the Oculoplastic Surgery Unit, Department of Clinical Ophthalmology, University Hospital of the São Paulo University (USP), São Paulo/SP, Brazil

Corresponding Author

ABSTRACT

Conjunctival cysts in anophthalmic socket may have functional and aesthetic implications for the patients.Among the available treatment options, the use of trichloroacetic acid is relatively recent. Our reported cases showed a good outcome after 30 days of treatment, that was well tolerated by patients, with greater conjunctival tissue preservation.

Keywords: Conjunctival diseases/drug therapy; Orbit; Trichloroacetic acid/therapeutic use; Trichloroacetic acid/administration & dosage; Eye, artificial; Case reports

INTRODUCTION

Conjunctival cysts are complications occurring in anophthalmic sockets which may cause local discomfort and difficulty fitting an ocular prosthesis on the anterior surface of the socket.

Therapeutic options include excision, marsupialisation and alcoholisation^(1,2). The use of trichloroacetic acid (TCA) is a relatively new alternative^(3,4).

This article reports on the use of 25% TCA in three cases of conjunctival cysts.

METHODS

Patients were placed in the supine position. One eye drop of 0.5% proxymethacaine was instilled 5 minutes and immediately before the procedure. After antisepsis, asepsis and placement of a blepharostat, the cyst was punctured with a 31×4 mm needle connected to a 3 ml syringe containing 1 ml of 25% TCA aqueous solution. The aspirated contents were then reinjected until the cyst acquired a whitish appearance. The contents were then reaspirated until the cyst walls collapsed.

Patients were then prescribed 0.3% ofloxacin and 1% prednisolone eye drops, one drop every 6 hours for 7 days. They were reassessed 7 days and 30 days after the procedure.

Case reports

Case 1. A 54-year-old male underwent evisceration of the left eye after having his eye pierced 2 years ago. He was referred to the Oculoplastic Surgery Unit of the University Hospital of the São Paulo University (HCFMUSP) with a conjunctival lesion that had been gradually increasing for 3 months and caused him to have difficulty using an ocular prosthesis.

The patient received a 1 ml intralesional injection of 25% TCA (Figure 1), but did not return for follow-up.

Case 2. A 56-year-old female underwent two tectonic corneal grafts in the left eye, the most recent 1 year ago. The case progressed to phthisis bulbi. She was referred to the Oculoplastic Surgery Unit of HCFMUSP with a conjunctival lesion that had been gradually increasing for 6 months. She reported discomfort on blinking.

The patient received a 1 ml intralesional injection of 25% TCA. She returned for follow-up 1 month after the procedure with no complaints (Figure 2).

Case 3. A 78-year-old female patient underwent evisceration of the left eye three years ago due to postoperative endophthalmitis. She was referred to the Oculoplastic Surgery Unit of HCFMUSP with a conjunctival lesion that had been gradually increasing for 9 months, causing discomfort while using an ocular prosthesis.

The patient received a 1 ml intralesional injection of 25% TCA. She returned for follow-up 1 month after the procedure with no complaints (Figure 3).

DISCUSSION

The procedure was well tolerated by all patients, who reported mild discomfort during the injection of 25% TCA.There were no complications during the study period, with adequate conjunctival regeneration and no relapse in the 2 patients who returned for follow-up.

The treatment of conjunctival cysts in anophthalmic sockets is required when it interferes with an ocular prosthesis, causes discomfort or has cosmetic implications for the patient.

Of the therapeutic options, the most common are excision and marsupialisation⁽¹⁾. However, these require a new surgical procedure, and complete resection of the cyst may be difficult, thus increasing the risk of relapse.

Hornblass et al.⁽²⁾ described a series of 4 cases treated with intralesional injection of absolute alcohol. Resolution was observed in 2 cases, but the follow-up time was not reported The use of TCA is described by Owji et al.⁽³⁾ in 4 patients with giant anterior conjunctival cysts in anophthalmic sockets. All patients were treated with intralesional injection of 20% TCA. The mean follow-up time was 16 months (range 8-33 months). No relapses were observed during this period.

Sánchez et al.⁽⁴⁾ used a TCA solution to treat a posterior conjunctival cyst in an anophthalmic socket; the lesion resolved and no relapse was observed during a follow-up period of 10 months.

In the cases reported here, the use of 25% TCA was simple, safe and effective for the duration of the follow-up period. Further studies are needed to assess its long-term effectiveness in a larger number of patients.

REFERÊNCIAS

• 1. McCarthy RW, Beyer CK, Dallow RL, Burke JF, Lessell S. Conjunctival cysts of the orbit following enucleation. Ophthalmology. 1981;88(1):30-5.
• 2. Hornblass A, Bosniak S. Orbital cysts following enucleation: the use of absolute alcohol. Ophthalmic Surg. 1981;12(2):123-6.
• 3. Owji N, Aslani A. Conjunctival cysts of the orbit after enucleation: the use of trichloroacetic acid. Ophthal Plast Reconstr Surg. 2005;21(4):264-6.
• 4. Sánchez EM, Formento NA, Pérez-López M, Jiménez AA. Role of trichloroacetic acid in treating posterior conjunctival cyst in an anopthalmic socket. Orbit. 2009;28(2-3):101-3.

Publication Dates

• Publication in this collection
  31 Oct 2013
• Date of issue
  June 2013

History

• Received
  14 Oct 2011
• Accepted
  21 Dec 2011