Abstract
Context. Tenon's cyst or conjunctival cyst formation is not uncommon late complication of traditional extracapsular cataract surgery; however, few reports are available in the literature. Aims. Large cystic swellings were clinically diagnosed as filtering blebs at the cataract incision site in two patients. The purpose of the case presentation is to discuss the factors leading to cyst formation, visual loss and cyst recurrence after its excision. Patients and Methods. Case 1. Sixty-one-year-old male patient presented with a bleb at superior limbal region in the right eye, two years after cataract surgery. Case 2. A giant bleb was found at the same region in the right eye of a 65-year-old male patient, eight years after cataract surgery. Results. Complete excision of the cyst was performed with conjunctival autograft in the first patient and followed up for two years. No recurrence of the cyst was observed. Internal wound gaping was seen on gonioscopy in the second patient. Conclusions. Unstable scleral tunnel could explain bleb formation in both the patients. Complete bleb excision with conjunctival auto-graft resulted in closure of the defect with no bleb recurrence during two-year follow-up. Over-filtration causing hypotonic maculopathy was the reason for decreased vision in the second case.
Highlights
Conjunctival inclusion cyst is a benign condition filled with serous fluid and slimy mucous secretions of congenital or acquired origin
Gonioscopic visualization of the fish mouthing of the internal opening was reported by previous authors on unplanned filtering blebs following cataract surgery [4]
A male patient aged about 61 years presented with a swelling in the right eye at the superior limbus for the last six months following cataract surgery with posterior chamber intraocular implantation
Summary
Conjunctival inclusion cyst is a benign condition filled with serous fluid and slimy mucous secretions of congenital or acquired origin. A filtering bleb is an intentionally created passage for aqueous humour into the sub-conjunctival space during glaucoma surgery but might be produced unintentionally following conventional manual small incision cataract surgery. The incidence rate from the previous reports on unintended filtering blebs after cataract surgery varied between 1% and 7.7% [2, 3]. Gonioscopic visualization of the fish mouthing of the internal opening was reported by previous authors on unplanned filtering blebs following cataract surgery [4]. Excision of the bleb with closure of the defect would result in improvement of vision even after many years [5]. The present case report highlights the importance of factors producing tenons cyst formation and its effects on vision, and to observe for post excision cyst recurrence after using the conjunctival auto graft for the closure of the defect
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