Letter to the Editor · Travail original · Originalarbeit

Abstract

Dear Sir, In the article ‘Iris Cyst in Aphakic Patient: Improvement of Visual Acuity after excision’ by Di Maria et al. [Ophthalmologica 1997;211:312–315], the authors describe their short-term result of partial resection of a postoperative cystic epithelial ingrowth of the iris and chamber angle by sector iridectomy. However, in our experience with over 100 patients with cystic or diffuse epithelial ingrowth treated by block excision [1–3] and by histopathologic studies of over 200 specimens with epithelial ingrowth [4], there is a definitive risk of transforming cystic ingrowth into diffuse epithelial downgrowth by partial removal of cystic epithelial ingrowth. Diffuse epithelial downgrowth is frequently relentlessly progressive and leads to loss of the eye. Therefore, we firmly believe that the treatment of choice for epithelial ingrowth is complete excision of all epithelial layers which usually requires block excision of the adjacent cornea, iris, chamber angle and ciliary body with a full-thickness corneoscleral graft. Although block excision of epithelial ingrowth may at first glance appear to be a rather aggressive procedure, our experience shows that the morphological and functional results of block excision are – with regard to the preoperative situation – generally good with no recurrence of epithelial ingrowth and avoidance of enucleation [1–3]. We strongly recommend not to treat cystic epithelial ingrowth with argon laser coagulation, YAG laser coagulation or partial excision because these procedures put the patient at an unnecessary and unacceptable risk of developing diffuse epithelial ingrowth with a poor prognosis. Epithelial ingrowth is a treatable condition if detected before it extends over more than 4–5 clock hours in the chamber angle and if treated adequately. Far too frequently, we have seen patients with advanced untreatable cystic or diffuse epithelial ingrowth who elsewhere had undergone previous unsuccessful surgical attempts to partially excise, ‘shrink’, ‘coagulate’ or ‘puncture’ cystic epithelial ingrowth.